Summary

History reveals he is a chronic smoker, drug abuser and

IVDU. He took amphetamine and heroin since age of 21
via both IV and chase. Frequency 2 to 3 times per week.
Last use of was 2 weeks ago. He denied tolerance,
intoxication and withdrawal symptoms, denied social
dysfunction. History of ingesting window glass and steel
2 months and 1 month ago respectively.
Why do people use substances?

1. Feel good

2. Can be calming
e.g. anxiety and
pain
3. Enhancement
e.g. to help concentration
and alertness to study

4. Social
bonding
Positive
reinforcement
REPEAT

REPEAT
Why do drug-addicted persons keep using drugs?

The reward pathway of the brain is connected to areas of the brain that
control behavior and memory. It begins in the ventral tegmental area, where
neurons release dopamine to make you feel pleasure. The brain begins to
make connections between the activity and the pleasure, ensuring that we
will repeat the behavior. Sometimes this pathway is helpful but other times, it
mbic system: The brains reward pathway

consists ofActivated
neurons that
by
release rewards
(e.g., food,
dopamin sex,
e drugs,
Amphetamine
etc.) & opiates

opiates
Route of entry
1.Oral
2.Inhalation/Smoki
ng
3.Snorting
4.Injection
Chasing the dragonisawayof
smokingheroin.

Itusuallyinvolvesplacingpowderedheroin

onfoilandheatingitfrombelowwitha

lighter.

Theherointurnstoastickyliquidand

wrigglesaroundlikeaChinesedragon.

Fumesaregivenoffandareinhaled

sometimesthorougharolledupnewspaper,

Injection
magazineortube.
 Opiate

Cannabis

Depressan
t
Common
Type of
ATS
drugs
NPS
Inhalant

Hallucinog
en
Mild to moderate intoxication from cocaine,
methamphetamine, or other stimulants is associated with euphoria, and a
sense of internal well-being, and perceived increased powers of thought,
strength, and accomplishment.
Opiate
Types
1. Opiate (Candu)
2. Heroin(Fit,Ubat,Panas,Stuff)
3. Morphine(Pokteh)
4. Codeine(Ubat Batuk)

Methadone
 When the body is introduced to heroin, the
body gets flooded with these opioids, leading to
enormously high levels ofdopamine.
Overstimulating the reward circuit of the brain

Upon entering the brain, enzymes convert heroin back into

morphine.
Once in morphine form, it quickly binds to opioid receptors in the
brain.
result of release of dopamine
 Dopaminergic
system (reward
pathway mediates
Opioid also affects addiction)
Noradrenergic
pathway

Diagnostic marker:
Urine heroine : 36-72 hours
morphine : 48 72 hours
methadone : 3 days
codeine : 48 hour

Heroin is more lipid soluble than morphine and more potent.

It crosses the BBB more rapidly, has a faster onset of action and
is more addictive
 Medical Complication of
Opioid
Complication due use
to overdose
- Coma
- Risk of vomiting and aspiration
- Respiratory distress due to overdose
- Delirium due to overdose

Complication due to IVDU

-Blood Borne Infection (Hep B&C, HIV, IE,Septicaemia & OM)
-Air embolism
-Thrombophlebitis, cellulitis, Local abscess
Opioid intoxication S/S
Intoxicatio
n S/S

Objective Subjective
Respiratory
depression Euphoria
CNS Decrease (total body Dysphoria
depression GI motility orgasm)

Respiratory Decreased
Analgesia Tranquility attention and
Depression
memory
Opioid
SlurredOverdose triad
N/V Drowsine Impaired
speech
ss judgement
Pin Point Coma
Hypotensio
pupil Bradycardi Psychomot
n a or
retardation
Pupillary
constrictio Seizure
n
Opioids Withdrawal
(S/S)
Analgesia Pain and irritability

Opioid Actions

Withdrawal sign
Respiratory depression Hyperventilation
Euphoria Dysphoria and depression
Relaxation and sleep Restlessness and insomnia
Tranquilization Fearfulness and hostility
Decreased BP Increased BP and PR
Constipation Diarrhea and N/V
Pupillary constriction Pupillary dilation
Hypothermia Hyperthermia (fever)
Drying of secretions Lacrimation, runny nose
Delayed ejaculation Spontaneous/Pre-
Flushed and warm skin ejaculation
Chilliness and piloerection
(gooseflesh)
Opioid Onset of Peak Resolution
withdrawal of
withdrawal
Morphine and 6-8 hours 48 hr-72 hr 7-10 days
heroin after last
dose
Methadone 1-3 days 3-8 days 2-3 weeks
Meperidine Quickly 8-12 hours 4-5 days
Buprenorphin 96 hours 4-5 days 7-10days
 ATS (Amphetamine-type
stimulants)
Amphetamine (Kuda,WY,yaba)
Methamphetamine (ice,syabu,sejuk,batu)
Ecstacy (goyang)

Cocaine-stimulant
The Effects of Amphetamine and Methamphetamine

Both drugs are psycho

stimulants, meaning they
increase a persons ability to
stay awake and even increase
focus.

Both raise the levels of

norepinephrine and dopamine
in the brain.

When these chemicals are

Effects of Amphetamine
Analeptic
Sympathomimetics
Stimulants
Psychostimulants
Increase performance and induce euphoric feeling

Abused by students studying for examinations, by

long distance truck drivers, by business people with
important deadline, by athletes in competition, and
by soldier during war time.
Amphetamine
Route of administration: Orally , IV and Inhalation
MOA: Release of dopamine from presynaptic nerve
terminals along Reward pathway from Ventral
tegmentum to cortex.
Legitimate medical indications of Amphetamine:
- Attention deficit disorder
- Narcolepsy
- Depression
Usually resolve within 24-48 hours
Methods of diagnosis
Diagnostic criteria
DSM 5

Diagnostic marker
Urine 48 hours
Hair Samples can be used to detect presence
presence of amphetamine-type stimulant up to 90 days

(DSM V pg 566)
 Chronic use
of
Amphetamin
e

Accelerated tooth
decay (Meth
Mouth)
Amphetamine
Overdose

-Hyperthermia,
-Dehydration
(especially after a
prolonged period of
dancing in a club
-Rhabdomyolysis
-Renal failure
Amphetamine Induced
psychotic disorder
Mimic paranoid Schizophrenia

Differentiating features: visual hallucinations,

appropriate affect, hyperactivity, hypersexuality, confusion,
incoherence, no disordered thinking, resolves in few days
and Urine Tox screen positive

Treatment: Short term Antipsychotic

What Factors Increase the Risk for
Addiction?

Home and family.Parents or older family members who abuse

alcohol or drugs, or who are involved in criminal behavior, can increase
young peoples risks for developing their own drug problems.

Peers and school.Friends and acquaintances who abuse drugs can

sway young people to try drugs for the first time. Academic failure or
poor social skills can also put a person at risk for drug use.
 Early use.Although taking drugs at any age can lead to addiction, research shows that the earlier

a person begins to use drugs, the more likely they are to progress to more serious use. This may

reflect the harmful effect that drugs can have on the developing brain. It also may be the
result of early biological and social factors, such as genetics, mental illness, unstable family

relationships, and exposure to physical or sexual abuse. Still, the fact remains that early use is a

strong indicator of problems aheadamong them, substance abuse and addiction.

Method of use.Smoking a drug or injecting it into a vein increases its addictive potential. Both

smoked and injected drugs enter the brain within seconds, producing a powerful rush of

pleasure. However, this intense "high" can fade within a few minutes, taking the person down to

lower levels. Scientists believe that this low feeling drives individuals to repeat drug use in an

attempt to recapture the high pleasurable state.