Asiri Rodrigo

Casual
Exploratory / experimental Social Emotional / Instrumental

Habitual
Harmful use /abuse Dependence

Intoxication- Transient syndrome due to recent substance ingestion which produces clinically significant physical or psychological impairment Harmful use- pattern of substance use that is causing physical or psychological harm

Craving Difficulty in controlling Tolerance Withdrawal Progressive neglect of alternative pleasures Persistence substance use despite harm

Alcohol Nicotine Cannabis Opioids Hallucinogens Stimulants Volatile substances

Second leading cause of death in the world Induces euphoria Stimulates hypothalamic-pituitary axis Causes a sharp increase in heart rate & blood pressure. Associated with depression Harm: lung cancer, laryngeal/bladder CA; second hand smoking also harmful asthma Management: education, nicotine replacement therapy (transdermal patches, gum, lozenge), drugs to prevent withdrawal symptoms - bupropion

The agent that effects change is tetrahydrocannabinol (THC) Produced from hemp plants Tolerance/ withdrawal in people who use high doses Withdrawal- Irritability, nausea, insomnia

Exaggerates the pre-existing mood Feeling of euphoria, relaxed, increased well-being Increased enjoyment of aesthetic experience Distortion of perception and time

Red eyes, dry mouth, tachycardia, cough Hazardous for drivers

Anxiety and paranoia Toxic confusional state Psychosis Clear connection between schizophrenia and cannabis Impaired foetal growing Carcinogenic

Heroin, Morphine, Codeine, Methadone, pethidine, etc. Acts on specific opioid receptors Rapid development of dependence and tolerance Route of use- IV, sniffing, sub-cutaneous administration, chasing the dragon

Euphoria and analgesia Respiratory depression, constipation, appetite & libido Pin point pupils Runs a chronic relapsing and remitting course IV use- abscess/ cellulitis / infection, thrombophlebitis, arterial embolism, Blood borne infections

Watery eyes Runny nose Yawning Cramps, Diarrhoea Loss of appetite Chills and sweating Piloerection (chicken skin)

Withdrawals are very distressing but not fatal Treat symptomatically NSAIDs, Loperamide, Metoclopramide Lofexidine/ Clonidine

Methadone and Buphrenophine Safe needle programme

Stimulants Amphetamines , Cocaine, Ecstacy Hallucinogens LSD, Phencyclidine, Psilocybin (magic mushroom) Benzodiazepines / Barbiturates Volatile substances (Solvents ) petrol containing solvents, aerosol, glues