Kolej Teknologi & Profesional Indera Kayangan

DFF 1022 INTRODUCTION TO PHARMACY PRACTICE
KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

DFG 1032
DRUG AND SOCIETY
DRUGS OF ABUSE
Part 1
LECTURER :
Mohammad Rosdi Omar
B.Pharm(AUST) RPh. MMPS

Learning Objective
• Upon completion of this topic, the students

should be able to:
• 1. Identify the different types of drugs of
abuse
• 2. Understand the characteristics of each type
of drugs of abuse

Definition of drug abuse
• Drug abuse is the non-medical use of drugs or

other chemicals for the purpose of changing
mood or inducing euphoria
• Drug abuse that results in the physical,

mental, emotional, and social impairment of
the user

Classification of abused drug
• Barbiturates - phenobarbitone
• Alcohol - ethanol
• The opioid drugs – codeine, morphine, heroine
• Cocaine
• Cannabis
• Amphetamines – ketamine, methamphetamine
• Hallucinogen - lysergic acid diethylamide
• Volatile organic solvents – glue, petrol, acetone
• Tobacco - nicotine

Tolerance and dependence of drug
• Tolerance: Body adaptation to drugs & larger

doses are required to produce the original effects
• Cross Tolerance: Development of tolerance to one

drug confers tolerance to another drug,
e.g. barbiturates, alcohol & other
sedatives/hypnotics

Dependence
It is an adaptive state and has the following properties:

1. Need to continue to take a drug –
pleasure & prevent withdrawal
2. Appearance of symptoms when abruptly
suspended
3.Need to increase the dose to sustain the initial
effects

Physical Dependence
• The body has adjusted to the presence of a drug to

avoid withdrawal symptoms
• The withdrawal symptoms is an abnormal and
unwell physiological state if the dependent
drug is stopped abruptly, it may be manifested by
yawn, flowing tears, fatigue, diarrhea, fear,
shivering, nausea, vomiting, and others.

Withdrawal Syndrome

Psychological Dependence
• Strong desire to experience the effects of the drug

repeatedly
• Craving for a drug is the most common
withdrawal symptom leading to continued
self-administration & compulsive drug
taking
• Psychological & physical dependences are not
mutually exclusive

METHODS OF TAKING DRUGS
• Oral ingestion
• Injection: intravenous(IV),
intramuscular(IM), or
subcutaneous(SC)
• Inhaling smoke
• Nasal sniffing

HEROIN AND OTHER OPIOD DRUGS
• Heroin (diacetylmorphine), also known

as diamorphine, is a semi-synthetic
opioid drug synthesized from
morphine, a derivative of the opium
poppy. The white crystalline form is
commonly the hydrochloride salt
diacetylmorphine hydrochloride .

Opium Poppy (Papaver somniferum)

Poppy Flower

Opium Extraction

Heroin

Type of Opioids
• Natural opiates: alkaloids contained in the resin of

the opium poppy, primarily morphine, codeine,
and thebaine. The leaves from Mitragyna speciosa
(also known as Ketum) contain a few naturally-
occurring opioids.
• Semi-synthetic opioids: created from the natural
opiates, such as hydromorphone, hydrocodone,
oxycodone
• Fully synthetic opioids: such as fentanyl,
pethidine, methadone, tramadol

Routes of Administration
Injection
• also known as "slamming", "banging", "shooting up" or "mainlining", is a
popular method used by addicts which carries relatively greater risks than other
methods of administration.
• Diacetylmorphine base, when prepared for injection will only dissolve in water
when mixed with an acid (most commonly lemon juice) and heated.
• Diacetylmorphine hydrochloride salt form, requiring just water to dissolve.
• Users tend to initially inject in the easily accessible arm veins, but as these
veins collapse over time, through damage caused by the acid, the user will
often resort to injecting in other veins. Intravenous users can use a various
single dose range using a hypodermic needle.
• The dose of diacetylmorphine used for recreational purposes is dependant on
the frequency and level of use, thus a first-time user may use between 5 and
20 mg, while an addict may require several hundred mg per day. As with the
injection of any drug, if a group of users share a common needle without
sterilization procedures, blood-borne diseases, such as HIV or hepatitis, can be
transmitted.

Injection

Smoking
• Smoking heroin refers to vaporizing it to inhale the
resulting fumes, not burning it to inhale the resulting
smoke.
• It is commonly smoked in glass pipes made from light
bulbs.
• It can also be smoked off aluminium foil, which is heated
underneath by a flame. This method is also known as
“chasing the dragon"

Insufflation (Snorting)
• Another popular route to intake diacetylmorphine is
insufflation (snorting), where a user crushes the
diacetylmorphine into a fine powder and then sharply
inhales it (sometimes with a straw or a rolled up
banknote, as with cocaine) into the nose where
diacetylmorphine is absorbed through the mucous
membrane of the nose and straight into the bloodstream.
• This method of administration redirects first pass
metabolism, with a quicker onset and higher
bioavailability than oral administration, though the
duration of action is shortened.
• This method is sometimes preferred by users who do not
want to prepare and administer diacetylmorphine for
injection or smoking, but still experience a fast onset
with a rush.

Suppository
• Little research has been focused on the suppository (anal
or vaginal insertion) method of administration, also
known as "plugging".
• This method of administration is commonly administered
using an oral syringe. Diacetylmorphine can be dissolved
and withdrawn into an oral syringe which may then be
lubricated and inserted into the anus or vagina before the
plunger is pushed.
• The rectum and the vaginal canal is where the majority of
the drug would likely be taken up, through the
membranes lining its walls.

Oral
• Oral use of heroin is less common than other methods of
administration, mainly because there is little to no "rush",
and the effects are less potent.
• Diacetylmorphine is entirely converted to morphine by
means of first-pass metabolism, resulting in deacetylation
when ingested.
• Heroin's absorption following oral administration is rather
low where about half of the dose only is being absorbed
and the bioavailability also is also low therefore making
oral route as a less popular choice.

Effects

BARBITURATES

BARBITURATES
• The barbiturates are a group of barbituric acid derivatives
used in medicine as sedatives and hypnotics.
Classification:
• long-acting barbiturates - onset of action 2 hours and
duration of action is 6 to 12 hours: barbitone,
phenobarbitone, phenytoin.
• Intermediate-acting barbiturates - onset of action half to one
hour and duration of action is 3 to 6 hours: amytal,
pentobarbitone, butobarbitone.
• Short-acting barbiturates - duration of action is less than 3
hours: secobarbital, thiopentone.
• Ultra short acting - onset of action is immediate and duration
of action is about 5 to 10 minutes Eg . Pentothal sodium,
hexobarbital sodium
Absorbtion, Distribution and Elimination
• They are rapidly absorbed from the

gastrointestinal tract including the rectum
and from the subcutaneous tissues.
• They are concentrated in the liver for a
short time and then evenly distributed in the
body fluids.
• They are partly destroyed in the liver and excreted
in urine.

Signs and Symptoms
• Acute poisoning may result from a single large

dose or repeated small dose.
• Usually the first symptom is drowsiness.
A short period of confusion, excitement, delirium
and hallucinations is common.
• Ataxia, vertigo, slurred speech, headache,
paraesthesias, visual disturbance may occur

Signs and Symptoms

• A stupor progressing to deep coma with loss
of superficial and deep reflexes and gradual
loss of painful stimuli occur.
• The Babinski sign may become positive.
• Respiration may be rapid and shallow or
slow and laboured.
• There is fall in cardiac output and an
increase in capillary permeability leading to
an increase in extracellular fluid.
• Progressive cardiovascular collapse
evidenced by cyanosis, hypotension, weak
rapid pulse and cold clammy
skin occurs.

Signs and Symptoms

• The pupils are usually slightly contracted but
react to light.
• Decrease peristalsis may occur in deeply
comatose patient.
• The urine may be scanty or suppressed and may
contain sugar and albumin.
• Incontinence of urine and faeces may occur.
• Blister on the skin, often on an area of erythema
strongly suggest barbiturate poisoning. It occurs
due to direct toxic action on the epidermis.

Signs and Symptoms
• Death may occur from respiratory failure

and ventricular fibrillation in early stages
and bronchopneumonia or irreversible
anoxia with pulmonary edema in the later
stages.
• The combination of alcohol and barbiturates
causes rapid death.

AMPHETAMINES

AMPHETAMINES
• Amphetamine is a psychostimulant drug of the

phenethylamine class that is known to produce increased
wakefulness and focus in association with decreased
fatigue and appetite.
• Amphetamine is a class of potent drugs that act by
increasing levels of dopamine and norepinephrine in the
brain, inducing euphoria.
• The drug is also used recreationally and as a performance
enhancer. Recreational users of amphetamine have given
numerous street names for amphetamine, such as speed,
ice, ecstacy and syabu.

Effects
Physical Effects
• Physical effects include anorexia, hyperactivity, dilated
pupils, blood shot eyes, flushing, restlessness, dry mouth,
bruxism (grind teeth), headache, tachycardia, bradycardia,
tachypnea, hypertension, hypotension, fever, diaphoresis,
diarrhea, constipation, blurred vision, aphasia, dizziness,
twitching, insomnia, numbness, palpitations, arrhythmias,
tremors, dry and/or itchy skin, acne, pallor, convulsions,
and with chronic and/or high doses, seizure, stroke, coma,
heart attack and death can occur.

Effects
Psychological effects
• Psychological effects can include euphoria, anxiety,
increased libido, alertness, concentration, energy, self-
esteem, self-confidence, sociability, irritability,
aggression, psychosomatic disorders, psychomotor
agitation, grandiosity, excessive feelings of power and
invincibility, repetitive and obsessive behaviors,
paranoia, and with chronic and/or high doses,
amphetamine psychosis can occur.

Effects
Withdrawal effects
• Withdrawal symptoms of amphetamine primarily
consist of mental fatigue, mental depression and an
increased appetite.
• Symptoms may last for days with occasional use and
weeks or months with chronic use, with severity
dependent on the length of time and the amount of
amphetamine used.
• Withdrawal symptoms may also include anxiety,
agitation, excessive sleep, vivid or lucid dreams, deep
REM sleep and suicidal ideation.

Amphetamines Harm Reduction


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DFF 1022 INTRODUCTION TO PHARMACY PRACTICE

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

• Upon completion of this topic, the students

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Definition of drug abuse

• Drug abuse is the non-medical use of drugs or

• Drug abuse that results in the physical,

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Classification of abused drug

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Tolerance and dependence of drug

• Tolerance: Body adaptation to drugs & larger

• Cross Tolerance: Development of tolerance to one

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

It is an adaptive state and has the following properties:

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

• The body has adjusted to the presence of a drug to

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

• Strong desire to experience the effects of the drug

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

METHODS OF TAKING DRUGS

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

HEROIN AND OTHER OPIOD DRUGS

• Heroin (diacetylmorphine), also known

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Opium Poppy (Papaver somniferum)

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

• Natural opiates: alkaloids contained in the resin of

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Absorbtion, Distribution and Elimination

• They are rapidly absorbed from the

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Signs and Symptoms

• Acute poisoning may result from a single large

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Signs and Symptoms

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Signs and Symptoms

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Signs and Symptoms

• Death may occur from respiratory failure

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

• Amphetamine is a psychostimulant drug of the

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN

Amphetamines Harm Reduction