Author: Harshita Toshniwal -Assistant Professor, RR Institute, Bangalore
Drug:
The word “drug” derived from the Old French drogue by way of the Middle Dutch drogue vate, which referred to the dried goods contained in vats generally, is taken to mean a chemical that is used for a beneficial medical purpose.
Code of Federal Regulations (21 CFR 210.3, 2015) makes the following definitions under Rules for the Food and Drug Administration (with emphasis added):
• “Drug product means a finished dosage form, for example, tablet, capsule, solution, etc., that contains an active drug ingredient generally, but not necessarily, in association with inactive ingredients. The term also includes a finished dosage form that does not contain an active ingredient but is intended to be used as a placebo.”
• Active ingredient means any component that is intended to furnish pharmacological activity or other direct effect in the diagnosis, cure, mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body of man or other animals. The term includes those components that may undergo chemical change in the manufacture of the drug product and be present in the drug product in a modified form intended to furnish the specified activity or effect.
Drugs of abuse
Drug is a patterned use of a substance in which the user ingests the substance in quantity or with means neither approved nor supervised by health care specialist is known as Drug Abuse or Substance Abuse.
Abuse of Drug is not restricted to mood-transforming or psycho-active drugs. When an activity is performed as in the case of anabolic steroids for performance enhancement in sports and muscle gain against the rules and policies of the matter then it is known as substance abuse. That’s why psychoactive and mood-altering substances are not the only kind of drugs abused. Abusing the illicit drugs like stimulants, depressants, narcotics hallucinogens, cannabis, even thinner, paints and glues are also considered as drug abuse types.
Problems with impulse control and impulsive behavior are also come under the category of Drug Abuse. The drugs like alcohol, amphetamines, barbiturates, benzodiazepines (particularly alprazolam, lorazepam and clonazepam), cocaine, methaqualone and opioids are associated with the term Drug Abuse. Using and abusing these drugs may lead to criminal penalty adding to physical, social and psychological harm, each fully depending on local jurisdiction. Many cases are there where criminal or antisocial behavior are seen when the person is under the dominance of a drug. Even personality changes in individuals may occur as well for long time.
Classification of Drugs of Abuse
Based on their origin, drugs of abuse can be classified into following three categories:
1) Natural. - These are the drugs which are derived from plants and require little or no processing at all.
Example: Cannabis, opium, coca paste fall under this category.
2) Semi-synthetic. These drugs are produced by subjecting natural drugs to some
chemical processes.
Example: Heroin and cocaine are chief examples of semi-synthetic drugs.
3) Synthetic. These drugs are made absolutely through chemical processes.
Example: Methaqualone (mandrax), amphetamine type stimulants, diazepam, etc.
Most of the dangerous drugs of abuse fall either under semi-synthetic or synthetic
category of the abused drugs classification.
Based on their effects they produce The Controlled Substances Act (CSA) regulates five classes of drugs:
• Narcotics
• Depressants
• Stimulants
• Hallucinogens
• Anabolic steroids
Each class has distinguishing properties, and drugs within each class often produce similar effects. However, all controlled substances, regardless of class, share a number of common features.
All controlled substances have abuse potential or are immediate precursors to substances with abuse potential. With the exception of anabolic steroids, controlled substances are abused to alter mood, thought, and feeling through their actions on the central nervous system (brain and spinal cord) Some of these drugs alleviate pain, anxiety, or depression. Some induce sleep and others energize. Though some controlled substances are therapeutically useful the “feel good” effects of these drugs contribute to their abuse. The extent to which a substance is reliably capable of producing intensely pleasurable feelings (euphoria) increase the likelihood of that substance being abused.
DRUG ABUSE According to Controlled Substances Act -
When controlled substances are used in a manner of amount inconsistent with the legitimate medical use, it is called drug abuse. The non-sanctioned use of substances controlled in Schedules I through V of the CSA is considered drug abuse. While legal pharmaceuticals placed under control in the CSA are prescribed and used by patients for medical treatment, the use of these same pharmaceutical outside the scope of sound medical practice is drug abuse.
DEPENDENCE
In addition to having abuse potential, most controlled substances are capable of producing dependence, either physical or psychological.
Physical Dependence
Physical dependence refers to the changes that have occurred in the body after repeated use of a drug that necessitates the continued administration of the drug to prevent a withdrawal syndrome. This withdrawal syndrome can range from mildly unpleasant to life-threatening and is dependent on a number of factors, such as:
• The drug being used
• The dose and route of administration
• Concurrent use of other drugs
• Frequency and duration of drug use
• The age, sex, health, and genetic makeup of the user
Psychological Dependence
Psychological dependence refers to the perceived “need” or “craving” for a drug. Individuals who are psychologically dependent on a particular substance often feel that they cannot function without continued use of that substance. While physical dependence disappears within days or weeks after drug use stops, psychological dependence can last much longer and is one of the primary reasons for relapse (initiation of drug use after a period of abstinence). Contrary to common belief, physical dependence is not addiction. While individuals with a substance use disorder are usually physically dependent on the drug they are abusing, physical dependence can exist without addiction. For example, patients who take narcotics for chronic pain management or benzodiazepines to treat anxiety are likely to be physically dependent on that medication.
ADDICTION
Addiction is defined as compulsive drug-seeking behavior where acquiring and using a drug becomes the most important activity in the user’s life. This definition implies a loss of control regarding drug use, and the person with a substance use disorder will continue to use a drug despite serious medical and/or social consequences.
Drugs within a class are often compared with each other with terms like potency and efficacy. Potency refers to the amount of a drug that must be taken to produce a certain effect, while efficacy refers to whether or not a drug is capable of producing a given effect regardless of dose. Both the strength and the ability of a substance to produce certain effects play a role in whether that drug is selected by the drug user. It is important to keep in mind that the effects produced by any drug can vary significantly and is largely dependent on the dose and route of administration. Concurrent use of other drugs can enhance or block an effect, and substance abusers often take more than one drug to boost the desired effects or counter unwanted side effects. The risks associated with drug abuse cannot be accurately predicted because each user has his/her own unique sensitivity to a drug. There are a number of theories that attempt to explain these differences, and it is clear that a genetic component may predispose an individual to certain toxicities or even addictive behavior.
Narcotics: The term “narcotic” comes from the Greek word for “stupor” and originally referred to a variety of substances that dulled the senses and relieved pain. Though some people still refer to all drugs as “narcotics,” today “narcotic” refers to opium, opium derivatives, and their semi-synthetic substitutes. A more current term for these drugs, with less uncertainty regarding its meaning, is “opioid.” Examples include the illicit drug heroin and pharmaceutical drugs like OxyContin, Vicodin, codeine, morphine, methadone, and fentanyl.
WHAT IS THEIR ORIGIN?
The poppy Papaver somniferum is the source for all natural opioids, whereas synthetic opioids are made entirely in a lab and include meperidine, fentanyl, and methadone. Semi-synthetic opioids are synthesized from naturally occurring opium products, such as morphine and codeine, and include heroin, oxycodone, hydrocodone, and hydromorphone. Teens can obtain narcotics from friends, family members, medicine cabinets, pharmacies, nursing homes, hospitals, hospices, doctors, and the Internet.
What are common street names?
Street names for various narcotics/opioids include:
• Smack, Horse, Mud, Brown Sugar, Junk, Black Tat, Big H, Paregoric, Dover’s Powder, MPTP (New Heroin), Hilbilly Heroin, Lean or Purple Drank, OC, Ox, Oxy, Oxycotton, Sippin Syrup
What do they look like?
Narcotics/opioids come in various forms, including:
• Tablets, capsules, skin patches, powder, chunks in varying colors (from white to shades of brown and black), liquid form for oral use and injection, syrups, suppositories, and lollipops
How are they abused?
• Narcotics/opioids can be swallowed, smoked, sniffed, or injected.
What is their effect on the mind?
Besides their medical use, narcotics/opioids produce a general sense of well-being by reducing tension, anxiety and aggression. These effects are helpful in a therapeutic setting but contribute to the drugs’ abuse. Narcotic/opioid use comes with a variety of unwanted effects, including drowsiness, inability to concentrate, and apathy.
2. Stimulants -Stimulants speed up the body’s systems. This class of drugs includes:
• Prescription drugs such as amphetamines [Adder - all and dexedrine], methylphenidate [Concerta and Ritalin], diet aids [such as didrex, Bontril, Preludin, Fastin, Adipex P, ionomin, and Meridia] and illicitly produced drugs such as methamphetamine, cocaine, and methcathinone.
WHAT IS THEIR ORIGIN?
Stimulants are diverted from legitimate channels and clandestinely manufactured exclusively for the illicit market.
What are common street names?
Common street names for stimulants include:
• Bennies, Black Beauties, Cat, Coke, Crank, Crystal, Flake, Ice, Pellets, R-Ball, Skippy, Snow, Speed, Uppers, and Vitamin R
What do they look like?
Stimulants come in the form of:
• Pills, powder, rocks, and injectable liquids
How are they abused?
Stimulants can be pills or capsules that are swallowed. Smoking, snorting, or injecting stimulants produces a sudden sensation known as a “rush” or a “flash.”
Abuse is often associated with a pattern of binge use — sporadically consuming large doses of stimulants over a short period of time. Heavy users may inject themselves every few hours, continuing until they have depleted their drug supply or reached a point of delirium, psychosis, and physical exhaustion.
During heavy use, all other interests become secondary to recreating the initial euphoric rush.
What is their effect on the mind?
When used as drugs of abuse and not under a doctor’s supervision, stimulants are frequently taken to:
Produce a sense of exhilaration, enhance self-esteem, improve mental and physical performance, increase activity, reduce appetite, extend wakefulness for prolonged period, and “get high” Chronic, high-dose use is frequently associated with agitation, hostility, panic, aggression, and suicidal or homicidal tendencies. Paranoia, sometimes accompanied by both auditory and visual hallucinations, may also occur.
Tolerance, in which more and more drug is needed to produce the usual effects, can develop rapidly, and psychological dependence occurs. In fact, the strongest psychological dependence observed occurs with the more potent stimulants, such as amphetamine, methylphenidate, methamphetamine, cocaine, and methcathinone
Abrupt cessation is commonly followed by depression, anxiety, drug craving, and extreme fatigue, known as a “crash.”
What is their effect on the body?
Stimulants are sometimes referred to as uppers and reverse the effects of fatigue on both mental and physical tasks. Therapeutic levels of stimulants can produce exhilaration, extended wakefulness, and loss of appetite. These effects are greatly intensified when large doses of stimulants are taken. Taking too large a dose at one time or taking large doses over an extended period of time may cause such physical side effects as:
• Dizziness, tremors, headache, flushed skin, chest pain with palpitations, excessive sweating, vomiting, and abdominal cramps
3. Depressants
Depressants will put you to sleep, relieve anxiety and muscle spasms, and prevent seizures. Barbiturates are older drugs and include butalbital (Fiorina), phenobarbital, Pentothal, Seconal, and Nembutal. A person can rapidly develop dependence on and tolerance to barbiturates, meaning a person needs more and more of them to feel and function normally. This makes them unsafe, increasing the likelihood of coma or death.
Benzodiazepines were developed to replace barbiturates, though they still share many of the undesirable side effects including tolerance and dependence. Some examples are Valium, Xanax, Halcion, Ativan, Klonopin, and Restoril. Rohypnol is a benzodiazepine that is not manufactured or legally marketed in the United States, but it is used illegally.
Lunesta, Ambien, and Sonata are sedative-hypnotic medications approved for the short-term treatment of insomnia that share many of the properties of benzodiazepines. Other CNS depressants include meprobamate, methaqualone (Quaalude), and the illicit drug GHB.
WHAT'S THEIR ORIGIN?
Generally, legitimate pharmaceutical products are diverted to the illicit market. Teens can obtain depressants from the family medicine cabinet, friends, family members, the Internet, doctors, and hospitals
What are common street names?
Common street names for depressants include:
• Barbs, Benzos, Downers, Georgia Home Boy, GHB, Grievous Bodily Harm, Liquid X, Nerve Pills, Phennies, R2, Reds, Roofies, Rophies, Tranks, and Yellows
What do they look like?
Depressants come in the form of pills, syrups, and injectable liquids.
How are they abused?
Individuals abuse depressants to experience euphoria. Depressants are also used with other drugs to add to the other drugs’ high or to deal with their side effects. Users take higher doses than people taking the drugs under a doctor’s supervision for therapeutic purposes. Depressants like GHB and Rohypnol are also misused to facilitate sexual assault.
What is their effect on the mind?
Depressants used therapeutically do what they are prescribed for:
• To induce sleep, relieve anxiety and muscle spasms, and prevent seizures
They also:
• Cause amnesia, leaving no memory of events that occur while under the influence, reduce reaction time, impair mental functioning and judgment, and cause confusion Long-term use of depressants produces psychological dependence and tolerance.
What is their effect on the body?
Some depressants can relax the muscles. Unwanted physical effects include:
Slurred speech, loss of motor coordination, weakness, headache, lightheadedness, blurred vision, dizziness, nausea, vomiting, low blood pressure, and slowed breathing Prolonged use of depressants can lead to physical dependence even at doses recommended for medical treatment. Unlike barbiturates, large doses of benzodiazepines are rarely fatal unless combined with other drugs or alcohol. But unlike the withdrawal syndrome seen with most other drugs of abuse, withdrawal from depressants can be life threatening.
4. Hallucinogens
Hallucinogens are found in plants and fungi or are synthetically produced and are among the oldest known group of drugs used for their ability to alter human perception and mood.
WHAT IS THEIR ORIGIN?
Hallucinogens can be synthetically produced in illicit laboratories or are found in plants.
What are common street names?
Common street names include:
• Acid, Blotter, Blotter Acid, Cubes, Doses, Fry, Mind Candy, Mushrooms, Shrooms, Special K, STP, X, and XTC
What do they look like?
Hallucinogens come in a variety of forms. MDMA or ecstasy tablets are sold in many colors with a variety of logos to attract youth. LSD is sold in the form of impregnated paper (blotter acid), typically imprinted with colorful graphic designs.
How are they abused?
The most commonly abused hallucinogens among junior and senior high school students are hallucinogenic mushrooms, LSD, and MDMA (ecstasy). Hallucinogens are typically taken orally or can be smoked.
What is their effect on the mind?
Sensory effects include perceptual distortions that vary with dose, setting, and mood. Psychic effects include distortions of thought associated with time and space. Time may appear to stand still, and forms and colors seem to change and take on new significance. Weeks or even months after some hallucinogens have been taken, the user may experience flashbacks — fragmentary recurrences of certain aspects of the drug experience in the absence of actually taking the drug. The occurrence of a flashback is unpredictable, but is more likely to occur during times of stress and seems to occur more frequently in younger individuals. With time, these episodes diminish and become less intense.
What is their effect on the body?
Physiological effects include elevated heart rate, increased blood pressure, and dilated pupils.
5. Steroids
Anabolic steroids are synthetically produced variants of the naturally occurring male hormone testosterone that are abused in an attempt to promote muscle growth, enhance athletic or other physical performance, and improve physical appearance.
Testosterone, nandrolone, stanozolol, methandienone, and boldenone are some of the most frequently abused anabolic steroids.
WHAT IS THEIR ORIGIN?
Most illicit steroids are smuggled into the U.S. from abroad. Steroids are also illegally diverted from legitimate sources (theft or inappropriate prescribing). The Internet is the most widely used means of buying and selling anabolic steroids. Steroids are also bought and sold at gyms, bodybuilding competitions, and schools from teammates, coaches, and trainers.
What are common street names?
Common street names include:
• Arnolds, Juice, Pumpers, Roids, Stackers, and Weight Gainers
What do they look like?
Steroids are available in:
• Tablets and capsules, sublingual-tablets, liquid drops, gels, creams, transdermal patches, subdermal implant pellets, and water-based and oil-based injectable solutions. The appearance of these products varies depending on the type and manufacturer.
How are they abused?
Steroids are ingested orally, injected intramuscularly, or applied to the skin. The doses abused are often 10 to 100 times higher than the approved therapeutic and medical treatment dosages. Users typically take two or more anabolic steroids at the same time in a cyclic manner, believing that this will improve their effectiveness and minimize the adverse effects.
What is their effect on the mind?
Case studies and scientific research indicate that high doses of anabolic steroids may cause mood and behavioral effects. In some individuals, steroid use can cause dramatic mood swings, increased feelings of hostility, impaired judgment, and increased levels of aggression (often referred to as “roid rage”). When users stop taking steroids, they may experience depression that may be severe enough to lead one to commit suicide. Anabolic steroid use may also cause psychological dependence and addiction.
What is their effect on the body?
A wide range of adverse effects is associated with the use or abuse of anabolic steroids. These effects depend on several factors including age, sex, the anabolic steroid used, amount used, and duration of use. In adolescents, anabolic steroid use can stunt the ultimate height that an individual achieves. In boys, steroid use can cause early sexual development, acne, and stunted growth. In adolescent girls and women, anabolic steroid use can induce permanent physical changes, such as deepening of the voice, increased facial and body hair growth, menstrual irregularities, male pattern baldness, and lengthening of the clitoris.
In men, anabolic steroid use can cause shrinkage of the testicles, reduced sperm count, enlargement of the male breast tissue, sterility, and an increased risk of prostate cancer.
In both men and women, anabolic steroid use can cause high cholesterol levels, which may increase the risk of coronary artery disease, strokes, and heart attacks. Anabolic steroid use can also cause acne and fluid retention. Oral preparations of anabolic steroids, in particular, can damage the liver.
Users who inject steroids run the risk of contracting various infections due to non-sterile injection techniques, sharing of contaminated needles, and the use of steroid preparations manufactured in non-sterile environments. All these factors put users at risk for contracting viral infections such as HIV/AIDS or hepatitis B or C, and bacterial infections at the sight of injection. Users may also develop endocarditis, a bacterial infection that causes a potentially fatal inflammation of the heart lining.
Which drugs cause similar effects?
There are several substances that produce effects similar to those of anabolic steroids. These include human growth hormone (hHG), clenbuterol, gonadotropins, and erythropoietin.
Drug Abuse Prevention Programs –
Drug abuse has a pervasive effect on an entire community. Understanding drug use risk factors and spreading the word through prevention programs is the best defense against drug abuse.
Parental monitoring has been the most effective way to slow the expansion of drugs in family situations.
School drug prevention programs serve a valuable purpose in first time users aged 12-17.
Schools with strict compliance rules and counseling support have been successful at reducing usage.
The National Institute Against Drug Abuse (NIDA) has found that gains resulting from community drug prevention programs far outweigh the financial investment by the community.
Programs should make sure to address all aspects of drug abuse. This includes underage use of legal drugs such as alcohol and tobacco, illicit street drugs, inhalants and the inappropriate use of legal drugs such as prescription and over the counter drugs.
These programs must also be tailored to the specific needs of the audience. Having specialized programs for different genders, ages, cultures and ethnicities only make the programs more effective.
PROGRAMS FOR DRUG PREVENTION
As a matter of fact drug prevention begins with education. This education can take place at a number of levels including:
Family Based Drug Prevention- The prevention of drug abuse should start inside the family unit as early as possible. There are many obvious benefits of home-based drug prevention education including self-awareness, and the enhancement of parent-child communication skills and family bonding. Parental supervision and involvement are critical in adolescents. Parents must not only have a plan to educate their children on the dangers of drug use and abuse, but they must also establish and enforce family rules. This includes creating an effective system of monitoring their children’s activities.
School Based Drug Abuse Prevention Programs -. Drug abuse prevention should be addressed as early as preschool. Preschool children can benefit from learning how to handle aggression, solve problems, and communicate better so that they can avoid putting themselves at risk for drug abuse later in life. Middle and high school programs should focus on peer relationships, communication, assertiveness, drug resistance skills and developing anti-drug attitudes. School based prevention programs should be repeated often for the best level of success.
Community Based Drug Abuse Prevention Programs - Communities that make an effort to come together in the fight against drugs are sure to make an impact in the prevention of drug abuse. There are many places to establish these prevention programs including schools, churches and community-based clubs.
References
1. Administration, E. D. & Department of Justice, U S. (2020). Drugs of Abuse, A DEA Resource Guide: 2017 Edition. Lulu.com.
2. Lappas, N. T., & Lappas, C. M. (2016). Forensic Toxicology: Principles and Concepts (1st ed.). Academic Press.
3.https://www.google.com/search?rlz=1C1CHBD_enIN889IN889&sxsrf=ALeKk01681joCZbaQH0mlXRj1XbHMdvKhA:1622384742194&q=List+of+drug+prevention+programs&sa=X&ved=2ahUKEwiowvyRzvHwAhW0V3wKHceGAxYQ1QIwFnoECA0QAQ&biw=1366&bih=657#( Visited on -30th May, 2021)
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