Chapter 26

1. Chapter 26 Drug Abuse

2. Drug Abuse • Drug abuse is defined as the use of drugs for nonmedical purposes, usually with the intent of altering consciousness. • Both prescription and nonprescription drugs can be abused. 2

3. Drug Abuse • Psychological dependence is defined as a state of mind in which a person believes that he or she is unable to function without a specific drug. • Physical dependence is defined as the altered physiologic state that results from constantly increasing drug concentrations. • Physical dependence is determined to exist when the person experiences withdrawal symptoms during drug discontinuation. 3

4. Drug Abuse • Tolerance is defined as the need for dose increases in order to achieve the desired effect or if the same dose produces a diminished effect. • In persons that have addiction issues there is dependence and a desire to continue to use the drug. • Habituation is characterized by a desire to continue to use a drug for its effect. 4

5. Drug Abuse • Who Abuses Drugs? • Anyone can be a drug abuser. • Patients can be drug abusers. • Dental practitioners can be drug abusers. • Dental health care workers should become familiar with the different drugs that are abused as well as their patterns of abuse. • Many patients may present with abuse problems. 5

6. Drug Abuse • The most commonly abused drugs in the U.S. are alcohol, tobacco, and caffeine. • They are easily abused because they are readily accessible. • Most people do not consider them to be drugs. • Most people consider illegal drugs, opioid analgesics, benzodiazepines, and barbiturates as drugs of abuse. 6

7. Drug Abuse • Managing the Oral Health Care of Drug Abusers • Always check for oral lesions. • Many drug abusers have poor oral hygiene. • Avoid using other controlled substances in these people. • Aspirin and NSAID use may need to be avoided because of the increased risk of GI adverse effects. • Consider the patient’s liver status. 7

8. Drug Abuse • Managing the Oral Health Care of Drug Abusers • Oftentimes alcoholics have diminished liver capacity and lack vitamin K. They may be at higher risk for continued bleeding. • Dental hygienists are in an ideal position to help in promoting tobacco cessation. • Always check heart rate and blood pressure of known or suspected drug abusers. • Those abusing stimulants may not be able to receive epinephrine because of the increased risk of cardiac toxicity. 8