PHARMACY

PRACTICE-IIB
(Community, Social &
Administra?ve Pharmacy)
Community Pharmacy (Theory)
Credit Hours: 03 (6th Semester)
Lecture 05

Hussain Ali (PhD)

9th March 2017
 Drug Abuse and Misuse
OVERVIEW

•  Drugs have been part of our culture since the middle of
the last century. Popularized in the 1960s by music and
mass media, they invade all aspects of society.
•  An es@mated 208 million people interna@onally
consume illegal drugs
•  The most commonly used illegal drug is marijuana.
According to the United Na@ons 2008 World Drug
Report, about 3.9% of the world’s popula@on between
the ages of 15 and 64 abuse marijuana.
 Sta?s?cs of Drug Abuse in Pakistan 2013
Narco?cs Control Division:
•  Pakistan’s popula@on aged 15 to 64 suffer
from the devasta@ng consequences of
substance abuse.
•  The Report es@mates that six per cent or 6.7
million adults in Pakistan used drugs in 2012.
•  The majority of drug users are between 25 and
39 years of age.
•  Although 4.25 million individuals are
considered to be drug dependent
•  Of these drug users 80% were men and 20%
were women
 Terms and defini?ons
•  Drug: In medicine, it refers to any substance with the
poten@al to prevent or cure disease or enhance
physical or mental well-being.
•  In pharmacology, drug refers to any agent that
alters the biochemical or physiological processes of
@ssue or organism.
•  Street drug: Drug that is taken for non-medicinal
reasons (usually for mind-altering effects); drug abuse
can lead to physical and mental damage and (with
some substances) dependence and addic@on e.g.
Alcohol, heroin, methamphetamine, crack, cocaine and
marijuana (Cannabis).
Hard drug (lead to severe physical addic@on):
Drug that is generally considered to be more
dangerous, with a higher risk of dependence that
so\ drugs. e.g. Heroin, methamphetamine,
cocaine.

SoY drug: (do not cause physical addic@on):
lead to psychological dependency. This means
that people feel be^er when they have the drug.
e.g. lysergic acid diethylamide (LSD), Cannabis
Illicit drug: An illegal drug, can’t prescribed. e.g.
Cocaine, heroin, LSD, marijuana.
Designer drug: A synthe@c drug very similar in
chemical makeup to an exis@ng drug and thus
exer@ng similar.
Club drug: A drug whose use primarily occurs in
clubs, bars and trance pari@es. e.g. Rohypnol,
ketamine.
Diluents: Compounds such as sugars or baking
soda that are used to increase the bulk of the
drug sample.

Recrea?onal drugs: used for non medicinal
purposes, in par@cular, for fun or leisure. – e.g.
methamphetamine (potent psychos@mulant of
the phenethylamine), that is used to treat
a^en@on deficit hyperac@vity disorder (ADHD),
drive long distances

Adulterants: drugs that are added to mimic or
enhance the effects of the drug being offered.
Example, some@mes amphetamines have been
cut with caffeine or ephedrine
 Types of Abused Substances

Legal Substances: approved by law for sale over
the counter or by doctor's prescrip@on, include
caffeine, alcoholic beverages, nico@ne, and
inhalants (nail polish, glue, inhalers, gasoline).
Prescrip?on drugs: such as tranquilizers,
amphetamines, benzodiazepines, barbiturates,
steroids, and analgesics can be knowingly or
unknowingly overprescribed or otherwise used
improperly.
 Illegal Substances

•  Prescrip@on drugs are considered illegal when
diverted from proper use.
•  Morphine, and synthe@c opiates, such as fentanyl,
are most o\en abused by people in the medical
professions, who have easier access to these drugs.
•  Other illegal substances include cocaine and crack,
marijuana and hashish, heroin, hallucinogenic
drugs such as lysergic acid diethylamide,
phencycline or "angel dust", "designer drugs" such
as MDMA(3,4-methylenedioxy-methamphetamine)
(Ecstasy), and "party drugs" such as GHB (gamma
hydroxybutyrate).
Mo?va?ons for Drug Use:
•  People take drugs for many reasons, and they
may take s@mulants to keep alert, or cocaine
for the feeling of excitement it produces.
peer pressure, relief of stress, increased energy, to
relax, to relieve pain, to escape reality, to feel
more self-esteem, and for recrea7on.

•  Athletes and bodybuilders may take anabolic
steroids to increase muscle mass
 Drug Use, Misuse and Abuse

•  Drug use: could be as simple as someone taking
an aspirin to relieve the pain of a headache.

•  Drug misuse: improper or un-necessary use of

prescrip@on or nonprescrip@on drugs.
 Drug Use, Misuse and Abuse

•  Drug Abuse: being addicted to a drug or using a
drug habitually or con@nuous use of a legal drug
with the knowledge that it is hazardous to one’s
health (cigare^e smoking)

• Addic@on: Compulsive nature of the drug use
despite physical and/or psychological harm to the
user and society and includes both licit and illicit
drugs.
 Drug Use, Misuse and Abuse
Drug abuse is compulsive, excessive, and self-
damaging use of habit forming drugs or
substances, leading to addic@on or dependence,
serious physiological injury (such as damage to
kidneys, liver, heart) and/or psychological harm
(such as dysfunc@onal behavior pa^erns,
hallucina@ons, memory loss), or death. It is also
called substance abuse.

• Misuse: used the wrong way a few @mes
• Abuse: used the wrong way excessively.

 Drug Addic?on and Drug Abuse
Dependence: – Psychological dependence is
the subjec@ve feeling that the user needs the
drug to maintain a feeling of well-being. e.g.
cocaine – Physical dependence is characterized
by tolerance (the need for increasingly larger
doses in order to achieve the ini@al effect) and
withdrawal symptoms when the user is
abs@nent
 Factors that Contribute to Substance Abuse
•  Inherited risk factors
•  Environmental risk factors
§  Personal
§  Home & family
§  School & peer group factors
§  Socio-cultural aspects of one’s environment

Effects of Substance Abuse
•  The effects of substance abuse can be on
many levels:
•  on the individual,
•  on friends and family,
•  on society
 Effects of Substance Abuse- on individual
•  Around 10000 death causes by drug abuse in
USA every year.
•  Many drug users engage in criminal ac@vity,
such as burglary and pros@tu@on, to raise the
money to buy drugs, especially alcohol and are
associated with violent behavior.
Cocaine: anxiety, fa@gue, depression, and an acute
desire.
•  Marijuana and alcohol interfere with motor
control and are factors in many automobile
accidents.
•  Users of marijuana and hallucinogenic drugs
may experience flashbacks, unwanted
recurrences of the drug's effects weeks or
months a\er use.
•  Sharing hypodermic needles used to inject
some drugs drama@cally increases the risk of
AIDS and some types of hepa@@s.
•  Heroin withdrawal can cause vomi@ng, muscle
cramps, convulsions, and delirium.
 Effects of Substance Abuse-on friends and
family:
Marital problems and poor work performance -
Pregnant drug users, because of the drugs
themselves or poor self-care in general, bear a
much higher rate of low birth-weight babies than
the average.
 Effects of Substance Abuse on society

Drug abuse affects society in many ways.
•  In the workplace it is costly in terms of lost
work @me and inefficiency.
•  Drug-related crime can disrupt neighborhoods
due to violence among drug dealers, threats to
residents, and the crimes of the addicts
themselves.
•  Half of the highway deaths in the United States
involve alcohol.
 Treatment
•  Treatment of substance abusers depends
upon the severity and nature of the addic@on,
mo@va@on, and the availability of services.

Pharmacological treatment:
Figh@ng Substance Abuse
Supply Reduc@on
Reduc@on of demand for drugs
Legaliza@on and decriminaliza@on
Treatment (Pharmacotherapy)
•  Both pharmacological and behavioral
treatments are used, o\en augmented by
educa@onal and voca@onal services.
•  Treatment may include detoxifica@on,
therapy, and support groups, such as the 12-
step groups Alcoholics Anonymous, Narco@cs
Anonymous, and Cocaine Anonymous.
•  Disulfiram is a medicine used in the treatment
of alcoholism.
•  methadone or buprenorphine maintenance
programs for heroin addic@on.
 Types of Legal Drugs Abused
Alcohol
No. 1 drug problem in America & Europe
32% of high school seniors
41% of college students report having 5 or more
drinks in a row at least once in the past 2 years
Nico?ne
use occurs in the form of cigare^e, cigar, pipe
smoking, chewing tobacco and snuff
23.1% of high school seniors smoke cigare^es daily
430,700 deaths each year
$138 billion economic cost
 Types of Legal Drugs Abused
Over-the-counter (OTC) drugs
can be purchased without a doctor’s prescrip@on

Prescrip?on drugs
requires a physician’s wri^en instruc@ons
usually stronger than over-the-counter drugs

Marijuana
most abused illicit drug
amo@va@onal syndrome

 Types of Legal Drugs Abused
Opium, morphine, & heroin
Narco@cs numb the senses and reduce pain
produce tolerance and physical dependence
injec@on users are at high risk for becoming
infected with HIV

Cocaine
potent s@mulant
1.7 million Americans used in last 30 days
 Preven?on & Control of Drug Abuse
Ø  Primary
are aimed at those who have never used drugs, &
their goal is to prevent or forestall the ini@a@on of
drug use.
Ø  Secondary
seek to reach those who have begun drug use but
are not chronic drug abusers
Ø  Ter?ary
designed to provide treatment for abuse &
a\ercare

 Elements of Preven?on

q  Educa@on
q  Treatment
q  Public Policy
q  Law Enforcement

 Official Agencies & Programs
1.  Department of Jus@ce
•  Law enforcement; prisons, & other aspects of
jus@ce system
•  Drug Enforcement Agency
•  Lead governmental agency on drugs

2.  Department of Health & Human Services
•  Educa@on, automa@c protec@on & regula@on
•  Rapid diagnosis & interven@on with treatment
•  Substance Abuse and Mental Health Services
•  Na@onal Ins@tute on Drug Abuse.
 Official Agencies & Programs
3.  Substance Abuse and Mental Health Services
Administra@on (SAMSHA)
4.  Na@onal Ins@tute of Drug Abuse (NIDA)
lead federal research agency
5.  Food and Drug Administra@on (FDA)
federal regulatory agency for legal drugs
6.  State government
influence the outcome of drug wars through
advocacy, administra@ve aid and legisla@on

 Official Agencies & Programs
7.  Regional coordina@on offices
provide a link between state and local efforts

8.  Local agencies & programs
•  Local coordina@on councils
•  Preven@on through educa@on
•  Interven@on and treatment
•  Law enforcement

 Nongovernmental Drug Preven?on
and Control

q  Community-based drug educa@on

q  School-based drug educa@on
q  Workplace-based drug educa@on
 Voluntary Health Agencies
§  Mothers Against Drunk Drivers
§  Students Against Drunk Drivers
§  Alcoholics Anonymous
§  Narco@cs Anonymous
§  American Cancer Society

Role of Pharmacist in control of Drug Abuse
and Misuse

ü  educa@ng pa@ents on safe use of drug.

ü  ensure valid prescrip@ons issued for legi@mate
medical purposes.
ü  Pa@ent educa@on: safe use, storage and
disposal
ü  Prescrip@on drug monitoring programs