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An Overview of Drug Dependence

An Overview of Drug Dependence. S. Casey Laizure, PharmD Associate Professor of Clinical Pharmacy University of Tennessee Memphis,TN. Commonly Abused Drugs. Alcohol Cigarettes Benzodiazepines and barbiturates Opiates Cocaine and other stimulants Hallucinogens Inhalants Marijuana.

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An Overview of Drug Dependence

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  1. An Overview of Drug Dependence S. Casey Laizure, PharmD Associate Professor of Clinical Pharmacy University of Tennessee Memphis,TN

  2. Commonly Abused Drugs • Alcohol • Cigarettes • Benzodiazepines and barbiturates • Opiates • Cocaine and other stimulants • Hallucinogens • Inhalants • Marijuana

  3. Societal Costs • Lost productivity • Motor vehicle accidents • Medical costs • Crime • Legal drugs (alcohol and cigarettes) have the highest societal costs • Alcohol abuse and alcoholism cost society an estimated 148 billion dollars annually

  4. Definition of Terms • Drug misuse- inappropriate use of drug intended for therapeutic purpose • Drug abuse- use inconsistent with social norms with the intent of altering mood • Drug addiction or dependence- compulsive drug use • Physical dependence- abrupt discontinuation will cause withdrawal reaction

  5. Definition of Terms (cont.) • Drug tolerance- physiologic adaptation to drug effects • Withdrawal or abstinence syndrome- characteristic symptoms occurring after abrupt discontinuation • Alcohol dependence, alcohol addiction, and alcoholism are synonyms

  6. DSM-IV Criteria: Substance Dependence 3 must be present in last 12 months • Tolerance • Withdrawal • Substance taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to decrease use • Significant time spent acquiring drug or recovering from its effects • Drug use displaces normal social, recreational, or work activities • Continued use despite negative consequences

  7. Symptoms of Alcohol Intoxication • Slurred speech • Ataxia • Sedation • Loquacity • Psychomotor retardation • Mood changes • Euphoria

  8. Symptoms of Alcohol Withdrawal

  9. Symptoms of Opiate Intoxication • Apathy • Slurred speech • Miosis (pathognomonic for mu agonists) • Constipation • Euphoria/Dysphoria • Psychomotor retardation

  10. Symptoms of Opiate Withdrawal • Lacrimation • Diarrhea • Rhinorrhea • Fever • Piloerection • Muscle aches • Diaphoresis • Mydriasis

  11. Symptoms of Cocaine Intoxication • Euphoria • Hypervigilance • Motor agitation • Tachycardia • Mydriasis • Loquacity • Grandiosity • Elevated blood pressure • Sweating • Nausea and vomiting • Cardiotoxicity • Seizures

  12. Symptoms of Cocaine Withdrawal • Fatigue • Sleep disturbance • Anhedonia • Depression • Increased appetite

  13. Treatment of Intoxications • All (supportive) • Benzodiazepines (flumazenil) • Alcohol (none) • Opiates (naloxone) • CNS stimulants (lorazepam/haloperidol) • Hallucinogens (lorazepam/haloperidol)

  14. Alcohol Detoxification • GABA agonists used to prevent withdrawal • Commonly used medications • Chlordiazepoxide • Lorazepam • Phenobarbital

  15. Alcohol Detoxification • Vitamins • Alcoholics commonly thiamine and folate deficient • Megaloblastic anemia is a common finding • Thiamine 100 mg qday • Folic acid 1 mg qday • Multivitamin qday • Cyanocobalamin 100ug IM X 1

  16. Alcohol Detoxification • Other • Acetaminophen prn headache • Kaolin/pectin or aluminum hydroxide prn diarrhea • Magnesium hydroxide prn constipation • Promethazine IM or PO prn nausea and vomiting

  17. Benzodiazepine Detoxification • Carbamazepine • 200 mg b.i.d., Increase until level therapeutic, 8-12 ug/ml • PRNs • Vitamins • Lorazepam, clonazepam or other benzodiazepine if withdrawal symptoms cannot be controlled with carbamazepine

  18. Opiate Detoxification • Clonidine • Decreases sympathetic outflow from central nervous system • Monitor heart rate and blood pressure carefully • Methadone • If withdrawal symptoms not controlled by clonidine alone • Patient should not know methadone dose – crush tablets and mix in liquid

  19. Opiate Detoxification • Other • Ibuprofen prn for increased temperature and muscle aches • Methocarbamol prn for muscle cramps • Kaolin/pectin prn for diarrhea • Promethazine IM or PO prn for nausea and vomiting

  20. Cocaine Detoxification • No specific treatment

  21. Treatment of Drug Dependence • Behavioral (12 step) • first-step - admit they can't control drug use, that their life has become unmanageable • Cognitive • coping mechanisms to avoid drug seeking • Pharmacotherapy • Drugs to reduce craving

  22. Pharmacotherapy For Drug Dependence • Use of pharmacotherapy should be accompanied by behavioral therapy and/or teaching of copping skills • Only alcohol dependence is commonly treated with adjunctive pharmacotherapy

  23. Pharmacotherapy for Alcohol Dependence • Disulfiram • Aversive - N/V, palpitations, flushing, H/A, sweating, hypotension if alcohol consumed • Normal dose 250 – 500 mg per day • Naltrexone • Reduces drinking amount on relapse • Normal dose 50 mg per day

  24. Pharmacotherapy For Other Drug Dependencies • Opiates • Naltrexone: an opiate antagonist that blocks the effects of exogenously administered opiates • Benzodiazepines • Carbamazepine in doses to achieve concentrations of 8-12 ug/mL • Cocaine • Desipramine • Bromocriptine to reduce craving

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