Overdoses substance abusers

Diazepam is used primarily in the treatment of mental anxiety. In addition, it acts as a muscle relaxant for a variety of medical conditions. It may also be used as a sedative-hypnotic and anticonvulsant (e.g., for status epilepticus and drug-induced seizures). Diazepam may also be used to alleviate some of the symptoms associated with the following cholinesterase poisoning, substance abuse withdrawal, antihistamine overdose. Black Widow spider envenomation, and chloroquine overdose. As an anesthetic, diazepam may be used alone or in combination with other drugs for conscious sedation. 

A child is at increased risk of suicide if.. . the child has substance abuse problems. . . Alcohol increases the risk of suicidal behavior by worsening feelings of depression and by diminishing self-control. About half of those who attempt suicide are intoxicated at the time of the attempt.. . Drug overdose is the method most frequently used in suicide attempts." (See Suggested Reading, Merck, pp. 413414.)... 

Toxic Effects of Acute Overdoses Acute poisoning with tricyclic antidepressants or MAO inhibitors is potentially hfe-threatening. Fatalities are much less common since modern antidepressants have widely replaced these drugs however, suicide rates have not declined consistently as clinical usage of modern antidepressants has increased. Deaths have been reported with acute doses of 2 g of imipramine, and severe intoxication can be expected at doses >1 g, or about a week s supply. If a patient is severely depressed, potentially suicidal, impulsive, or has a history of substance abuse, prescribing a relatively safe antidepressant agent with close clinical follow-up is appropriate. If a potentially lethal agent is prescribed, it is best dispensed in small, sublethal quantities, with the risk that sustained adherence to recommended treatment may be compromised. 

Fentanyl transdermal system Fentanyl transdermal systems contain a high concentration of the potent schedule II opioid agonist, fentanyl. Schedule II opioid substances have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. Fentanyl can be abused and is subject to criminal diversion. The high content of fentanyl in the patches may be a particular target for abuse and diversion. 

There is increasing concern over the street abuse of dextromethorphan, which is available in a variety of products. There have been a few reports of abuse and a handful of case reports of overdose and death. Nevertheless, dextromethorphan was specifically left out of the Controlled Substances Act (CSA) of 1970 and has not been added to the Drug Enforcement Administration (DEA) scheduling process despite these reports. This decision was made because dextromethorphan is not considered a narcotic and is generally thought to have a low addiction potential. However, the DEA is monitoring dextromethorphan and may add it to its list of controlled substances at some point in the future. 

Glutethimide (Doriden), a highly lipid-soluble drug classified as a sedative-hypnotic, was introduced in 1954 as a safe barbiturate substitute. However, its addiction potential and the severity of withdrawal symptoms were similar to those of barbiturates. In 1991, glutethimide was classified as a Schedule II controlled substance in response to an upsurge in the prevalence of diversion, abuse, and overdose deaths. The drug is illegal in the United States and in several other countries. It is classified as a sedative-hypnotic. 

By 1972, luding out —taking methaqualone with wine—was popular on college campuses. Excessive use of the drug leads to tolerance, dependence, and withdrawal symptoms similar to those of barbiturates. Overdose by methaqualone is more difficult to treat than barbiturate overdose, and deaths have frequently occurred. In the United States, the marketing of methaqualone pharmaceutical products was discontinued in 1984, and the drug became a Schedule I controlled substance. However, some level of occasional abuse has continued. 

The treatment of narcolepsy with psychostimulants such as amphetamine 2 (Adderall), and methylphenidate 3 (Ritalin) has been reported.3 However, these are schedule 2 DEA-controlled substances and have a potential risk of abuse, overdose, and dependence, which present substantial barriers to widespread use.4 As a result, there has been a significant effort to identify novel therapeutic agents for the... 

For drugs with a potential for abuse, information relating to the abuse of the drug as well as a proposal for scheduling under the Controlled Substances Act should be included. If the drug is structurally or pharmacologically related to a drug with abuse potential, but no studies have been done, the reasons why these studies are considered unnecessary should be included. Information related to overdose, as well as antidotes, other treatments, and measures to be taken in the case of overdose must also be provided. 

Diuretics are used to treat oedema in heart failure, liver cirrhosis, hypertension and certain kidney diseases. Some diuretics, such as acetazolamide, make the urine more alkaline and are helpful in increasing excretion of substances such as aspirin in cases of overdose. Diuretics are often abused by sufferers of eating disorders (e.g. bulimia) in an attempt at weight loss. 

Scientists have discovered narcotic receptors in the brain, along with natural pain killing substances produced by the body called endorphins. Narcotics behave like endorphins and act on, or bind to, the receptors to produce their associated effects. Substances known as narcotic or opioid antagonists, are drugs that block the actions of narcotics and are used to reverse the side effects of narcotic abuse or an overdose. A new elass of drugs, a mixture of opioids and opioid antagonists, has been developed so that patients can be relieved of pain without the addictive or other unpleasant side effeets associated with narcotics. Most countries have strict laws... 

Certain pharmaceutical drugs and other substances are classified as drugs of abuse because of the tendency for people to use (or overuse) these substances for other than their intended purpose and in some cases become addicted. Because of the adverse health, sociological, and other consequences of using these substances, availability and quantity of many - but not all - of these substances are controlled by regulatory agencies. This article surveys major classes and provides specific examples of drugs of abuse, the main adverse effects, treatments available in overdose situations, and withdrawal symptoms, if applicable. 

---