SUBSTANCE AND DRUG TYPES
Drug addiction is a chronic, relapsing disease that causes compulsive drug seeking and use despite harmful consequences and long-lasting changes in the brain to the drug addict (NIDA, 2020b). Although it is true that, for most people, the initial decision to take drugs is voluntary, over time the changes in the
brain caused by repeated drug use can affect the individual’s self-control and ability to make sound decisions. The two major drug categories discussed in this course are illicit drugs (also referred to as street drugs or club drugs) and prescription drugs.
ILLICIT DRUGS
Overview Illicit drugs are a pharmacologically heterogeneous group of synthetic opioids or psychoactive or “other” compound that may be abused by teens and young adults. Club drugs are often seen at nightclubs, bars, raves, or trance scenes and were made popular through the rave phenomenon in the United States (Dryden-Edwards, 2021). Heroin, bath salts, cocaine, LSD, PCP, MDMA (ecstasy), salvia, spice, mushrooms, Heroin Heroin (diacetylmorphine) is derived from the morphine alkaloid found in opium and is roughly two to three times more potent than morphine (NIDA, 2021b). As defined by the Drug Enforcement Agency (DEA, n.d.), heroin is a Schedule 1 substance under the Controlled Substances Act, which means it has high potential for abuse, has no accepted medical use for treatment in the United States, and lacks accepted safety for use even under medical supervision. According to NIDA (2021b), the first-time users doubled from 2006 to 2016 with a reported 170,000 people newly using. In the United States during 2016 (the latest data available) there were a reported 948,000 users of heroin within the past year. Heroin use has replaced other higher priced, commonly abused opiates and has become the drug of choice in the United States. Its use has increased rapidly since 2010. However, a significant decline in 2016 was also noted among 8th, 10th, and 12th graders. This decline was the lowest it had been since 1991, with less than 1% reporting in each grade level (NIDA, 2021b). Heroin is a white or brown powder or black sticky substance that can be injected, inhaled, or smoked. It is an opioid derived from the opium poppy flower. Once ingested, it is quickly metabolized to morphine and other metabolites that bind to opioid receptors in the brain. New forms of heroin are available and much cheaper. Cheese heroin is a combination of Mexican black tar heroin and cold medicine obtained over the counter. It is a highly addictive substance, very inexpensive (only a few dollars), and is therefore often targeted to young people. Children as young as nine years old have been identified in emergency rooms with addiction, overdose, and withdrawal to this form of heroin, which suppresses the central nervous system causing breathing and heartbeat to slow or stop (Foundations for a Drug-Free World, 2006–2021). Following ingestion of any form of heroin is a surge of euphoria (the rush) accompanied by a warm flushing of the skin, a dry mouth, analgesia, and slowed breathing and heart rate. Following the initial euphoria, the users will be drowsy, and mental function is cloudy (NIDA, 2021b). (Box 1) Healthcare Considerations: Heroin produces a profound degree of tolerance as well as physical dependence. Once a person has a heroin use disorder, their primary purpose in life is to seek and use the drug. Healthcare professionals in the emergency department setting need to be aware that withdrawal symptoms include feelings of drug craving, restlessness, muscle and bone pain, insomnia, diarrhea, and vomiting (NIDA, 2021b). The individual may experience cold flashes and shivering. Major withdrawal symptoms peak between 48 and 72 hours after the last dose is stopped and may last up to one week.
and methamphetamine are common drugs that are abused by teenagers and young adults. These drugs are dangerous because there is no way of knowing how strong the drug actually is or what exactly is in the drug (Dryden-Edwards, 2021). Prescription and synthetic opioids and marijuana are also commonly abused drugs and will be discussed.
Box 1: Heroin: Clinical Signs
Short-Term
Long-Term
• Euphoria • Flushing of skin • Dry mouth • Heavy extremities • Itching • Decreased mental functioning
• Altered level of consciousness • Collapsed veins • Hypotension • Muscle spasms • Seizure • Coma • Possible death
• Respiratory depression • Constricted (pinpoint) pupils • Nausea • Bradycardia • Abscesses
Note. NIDA, 2021b. Tolerance develops with regular heroin use, and the abuser must use more of the drug to get the same effect or substance intensity. As higher doses are used over time, physical dependency and addiction develop. With physical dependence, the body adapts to the presence of the drug, and withdrawal symptoms may occur within a few hours of nonuse. There may be feelings of drug craving, restlessness, muscle and bone pain, insomnia, diarrhea, and vomiting (NIDA, 2021b). There may also be cold flashes and shivering. Major withdrawal symptoms may peak between 48 and 72 hours after the last dose is stopped and may last up to one week. Sudden heroin withdrawal by heavy users can result in death (NIDA, 2021b). Beyond the immediate withdrawal symptoms of heroin, there may be long-term consequences. Ongoing heroin use can lead to collapsed veins, gastrointestinal problems, liver disease, kidney disease, brain damage, and needle contamination diseases such as HIV. Heroin use during pregnancy may cause a spontaneous abortion or lead to premature birth, neonatal abstinence syndrome, low birth weight, slow weight gain, or birth defects (NIDA, 2021b). Treating heroin addiction and/or overdose There are three types of medications that can be used to treat heroin addiction. Methadone has been used since the 1960s to treat heroin addiction. The use of this medication for opiate dependency is highly regulated within the United States, and use for treating heroin differs among states. Oral methadone, a slow- acting opioid agonist, is approved for opiate detoxification and maintenance only in approved and certified treatment programs, although certain emergency and inpatient care exceptions may exist (NIDA, 2021b). Buprenorphine is a partial opioid agonist which relieves drug cravings without producing the “high.” Unlike the strict regulation of methadone daily monitoring,
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