Treatment of hallucinogen use disorder and intoxication No known hallucinogen-specific antidotes exist. Treatment of patients who are intoxicated following the use of hallucinogens must be monitored closely. Benzodiazepines are commonly used to treat the side effects to protect that patient from complications of agitation that are listed previously. Supportive treatment with intravenous fluids and monitoring of
vital signs is important. The use of neuroleptics such as Haldol can be considered if the agitation is not completely controlled with the use of appropriate doses of benzodiazepines. At this time, no approved pharmaceutical treatment for hallucinogen use disorder is available.
INHALANT USE DISORDER
Inhalants are substances that produce chemical vapors that can be inhaled to induce psychoactive or mind- altering effects. The range of chemicals with a variety of pharmacologic effects are found in hundreds of products. Precise categorization of these products is difficult, but generally they are identified as volatile solvents, aerosols, gases, and nitrates: 51 ● Solvents include paint thinner, gasoline, lighter fluid, and glue. ● Aerosols include spray paint, hair spray, and vegetable oil sprays. ● Gases include propane tanks, whipped cream aerosols, and butane lighters and nitrous oxide. ● Nitrates include room odorizrs and leather cleaner. Inhalants are CNS depressants and influence gamma- aminobutyric acid (GABA). Physiologic effects of inhalant use include a variety of body functions. Most of the damage initially affects the brain, observed through tremors and uncontrolled shaking. Headaches and seizures are common. Personality changes, memory loss, and decreased cognitive functioning may also develop. Inhalants can also cause lung damage with hypoxia, sinus discharge, coughing, and cyanosis. Arrhythmias, heart block, and heart Treatment of inhalant use disorder and intoxication Like many other drugs of abuse, no specific antidote or reversal agent exists for inhalant use or intoxication. Supportive care for the respiratory effects of stimulants may include oxygen or beta-agonists to treat bronchospasm. Nitrous oxide that is commonly found in whipped cream canisters may have effects on vitamin B 12 metabolism, and the neurotoxicity found in chronic use of this inhalant may be reversible with administration of vitamin B 12 (cyanocobalamin). 140
failure are also possible with inhalant use. Other medical effects associated with inhalant use include gastrointestinal, liver, and kidney failure; bone marrow damage; and peripheral nervous system effects. Venous thromboembolism can be associated with inhalant use. Psychological effects of inhalant use include impaired judgment, hyperactivity, aggressive behavior, speech problems, and increased accidents, especially unplanned suicides in children who use inhalants. 52 Inhalation of hydrocarbons in the setting of catecholamine surge has resulted in fatal overdoses in otherwise young healthy patients. Sudden sniffing death is a rare but dangerous complication of inhalant use disorder. It is thought to be due to myocardium sensitization to catecholamines that is possibly accentuated by hypoxia associated with inhalant misuse, causing fatal dysrhythmias. 139 Individuals who try to quit inhalants may experience withdrawal symptoms including nausea, loss of appetite, diaphoresis, problems sleeping, and mood changes. Chronic inhalant abuse can lead to withdrawal symptoms in absence of use, with symptoms similar to other withdrawal syndromes, such as irritability, nausea, vomiting, diaphoresis, tachycardia, hallucinations, or delusions. Treatment of inhalant use disorder can include pharmacotherapy or behavioral interventions. Multiple medications have been suggested for treatment of inhalant use disorder such as benzodiazepines, barbiturates, antipsychotic agents, lamotrigine, and buspirone.
TOBACCO USE DISORDERS/VAPING
Tobacco use is widespread in the United States, and its deleterious effects are well documented. Smoking cigarettes lead to disease and disability in almost every organ in the body. Heart disease, stroke, lung disease, diabetes, and chronic obstructive pulmonary disease as well as multiple types of cancer are directly associated with smoking. Additionally, there is an increased risk for tuberculosis, eye diseases, and immune diseases. Secondhand smoke is also detrimental to nonsmoking adults and children including stroke, lung cancer, sudden infant death syndrome, middle ear disease, worsening asthma, acute respiratory infections, and slowed lung growth.
The strongest predictors of nicotine addiction are the time to first cigarette and total cigarettes per day. 53 The cigarette is a highly efficient drug delivery system. On average, the individual takes in 1-2 milligrams of nicotine per lit cigarette and takes 10 puffs over a 5‑minute period. This equates to 200 hits of nicotine to the brain daily. 54 Nicotine stimulates catecholamine release by an activation of nicotine acetylcholine receptors, and this results in increases in increases in blood pressure, respiratory, and heart rates. It also stimulates reward pathways in the brain and is highly addictive. Frequent dosing is necessary to prevent withdrawal symptoms in most patients.
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Book Code: MDCO1025
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