Physical symptoms, drug abuse

Drug abuse and dependence These drugs are chemically and pharmacologically related to the amphetamines and have abuse potential. Intense psychological or physical dependence and severe social dysfunction may be associated with long-term therapy or abuse. If this occurs, gradually reduce the dosage to avoid withdrawal symptoms. 

Once an amphetamine abuser stops taking the drug, withdrawal symptoms begin as the body tries to adjust to the absence of the stimulant. This results in very uncomfortable and potentially life-threatening physical symptoms, called withdrawal syndrome. According to the World Health Organization (WHO), withdrawal is experienced by 87% of amphetamine users who stop the drug. 

Sympathomimetics can be physically addictive and should not be prescribed to people with a history of drug abuse. A person may develop a tolerance to the drug and attempt to increase the dosage. The person may develop intoxication symptoms such as insomnia and severe skin diseases. 

Drug tests are infrequently used to detect inhalant abuse. More often, a diagnosis is made after physical symptoms of inhalant abuse are noticed or become apparent (intoxication, chemical smell on breath and clothing, weight loss, and illness), and the diagnosis is made by a physician. There is no standard drug test available to detect the use of inhalants because of the sheer number of chemicals abused. 

Panic disorders, with or without agoraphobia, affect 1.6% of the adult population (>3,000,000 people) in the United States at some time in their lives. In panic disorder, brief episodes of fear are accompanied by multiple physical symptoms, such as terror, fear of dying, heart palpitations, difficulty in breathing, and dizziness. Panic attacks recur and the victim develops an intense fear of having another attack, which is termed anticipatory anxiety. In addition, the victim may develop irrational fears, called phobias, that relate to situations in which a panic attack has occurred. This condition may coexist with other phobias (agoraphobia, simple phobia, social phobia), depression, obsessive-compulsive disorder, alcohol and drug abuse, suicidal tendencies and irritable bowel syndrome. 

The plan of care for a patient who is a drug abuser will depend on the reason for hospitalization. The physical response to drug use should be monitored and any infections or disease states must be treated. The plan should also include treatment for the abuse in a supportive and rehabilitative setting. This may include counseling, psychotherapy sessions, and medications to overcome the withdrawal symptoms. 

Chronic administration of opiates and alcohol leads to physical dependence a phenomenon, which is only weakly expressed following chronic administration of psychostimulants or other drugs of abuse. Physical dependence results from neuroadaptive intracellular changes to an altered pharmacological state. Abstinence from chronic opiate or alcohol use leads to a variety of physiological and psychological withdrawal symptoms based on these adaptations of the neuronal system. 

Treatment of drug addicts can be sqDarated into two phases detoxification and relapse prevention. Detoxification programs and treatment of physical withdrawal symptoms, respectively, is clinically routine for most drugs of abuse. However, pharmacological intervention programs for relapse prevention are still not veiy efficient. 

Controlled substances are the most carefully monitored of all drugs. These drags have a high potential for abuse and may cause physical or psychological dependence Physical dependency is a compulsive need to use a substance repeatedly to avoid mild to severe witii-drawal symptoms it is die body s dependence on repeated administration of a drug. Psychological dependency is a compulsion to use a substance to obtain a pleasurable experience it is die mind s dependence on the repeated administration of a drag. One type of dependency may lead to die odier typa... 

The continued use of opioids results in the development of physical dependence, as demonstrated by the appearance of a characteristic abstinence syndrome upon interruption or cessation of use. The symptoms of withdrawal include hyperactivity, anxiety, restlessness, yawning, diarrhea, vomiting, chills, fever, lacrimation, and runny nose. Piloerection (gooseflesh or cold turkey), mydriasis, increased blood pressure and heart rate, and hyperpyrexia may be observed. Tremors, abdominal cramps, and muscle and joint pain may be present. Drug craving is an important feature of opioid withdrawal. In contrast to some other drugs of abuse, withdrawal is not life threatening. 

Geriatric Considerations - Summary Diphenoxylate is an analog of meperidine and can cause opiate adverse effects. When discontinued, physical dependence and withdrawal symptoms can occur. Adverse GI effects such as constipation, nausea/vomit-ing, and abdominal pain may result from normal doses. Afropine is added to discourage abuse but can cause anticholinergic adverse effects in the older adult. The benefits of f his drug combination for older adulfs are limifed by fhe risk of adverse effects. 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Methadone is widely used in the treatment of opioid abuse. Tolerance and physical dependence develop more slowly with methadone than with morphine. The withdrawal signs and symptoms occurring after abrupt discontinuance of methadone are milder, although more prolonged, than those of morphine. These properties make methadone a useful drug for detoxification and for maintenance of the chronic relapsing heroin addict. 

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