Substance Abuse

Chapter 12 Substance Abuse



The National Institute on Drug Abuse (NIDA) calls drug abuse and addiction “one of America’s most challenging public health problems.”1 Substance abuse places a tremendous burden on society, affects every aspect of life, and has been called “an equal opportunity destroyer.”1 It is also an expensive national problem. NIDA estimates that drug abuse and addiction costs the United States more than $500 billion annually.2 The cost of drug abuse includes the loss of earning potential of those addicted and the loss of wages of those injured by accidents caused by impaired persons. Included in the societal cost of substance abuse are law enforcement salaries, legal fees, and the cost of maintaining federal prison facilities needed for those incarcerated as a result of drug-related offenses. An estimated 31% of America’s homeless population have addiction issues.1 NIDA also notes that 50% to 80% of all child maltreatment cases involve some form of substance abuse by the child’s caregivers.1


An estimated 19.5 million Americans age 12 years and older are current users of illegal drugs. More than 51% of America’s teenagers have at least tried an illegal drug before they leave high school.1 In 2008 more than 31 million people admitted to driving while under the influence of alcohol at least once in the past year3 (see Chapter 13, Alcohol Abuse). According to the National Survey on Drug Use and Health (NSDUH), current cocaine use gradually declined between 2003 and 2009 among people age 12 years and older (from 2.3 million to 1.6 million).16


Drug abuse and addiction is a preventable disease, and education on the scope of the problem and available resources in individual communities can assist health care providers in dealing with substance abuse.



Anabolic Steroids


Recent international scandals in professional sports have highlighted the dangers of steroid use. Anabolic-androgenic steroids, sometimes called “roids” or “juice,” are synthetic substances similar to testosterone. While anabolic steroids have legitimate medical uses, they should not be used simply to build up muscle bulk. The most common names of abused anabolic steroids are Andro, oxandrolone (Oxandrin), methandrostenolone (Dianabol), stanozolol (Winstrol), nandrolone decanoate (Deca-Durabolin), and boldenone undecylenate (Equipoise).4





Cocaine


Cocaine is a strong central nervous system stimulant that is highly addictive. NIDA reports that, in 2008, 5.3 million Americans age 12 years and older had abused cocaine in some form.5 There are many street names for cocaine, including blow, bump, C, candy, Charlie, coke, flake, rock, snow, and toot.5


“Crack,” another street name, is given to the form of cocaine that has been processed to make a rock crystal, which when heated produces vapors that are smoked. The term “crack” refers to the crackling sound produced by the rock as it is heated.


There are three common ways in which cocaine is used.



The faster the drug reaches the brain, the more intense the user’s high will be; the duration of the high, however, depends on the route administered and the purity of the cocaine used. To maintain their highs, people who take cocaine will frequently “binge,” a process of ingesting, inhaling, or injecting cocaine several times in rapid succession. Regardless of the route chosen, the person quickly becomes addicted.


Cocaine dealers frequently dilute their product with other substances, both active and inert, to increase or decrease its potency. This dilution process complicates the patient assessment and treatment, as the substances added to the cocaine may be toxic and contribute to the patient’s symptoms.





Heroin


NIDA reported that the number of current heroin users in the United States age 12 years and older rose from 153,000 in 2007 to 213,000 in 2008.9 In the same year 114,000 first-time heroin users were reported.9 Heroin’s street names include brown sugar, dope, H, horse, junk, skag, skunk, smack, and white horse.10


Heroin is an opiate drug synthesized from morphine. It is a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin typically comes in a white or brown powder or as a black, sticky substance known as “black tar” heroin. The substance can be injected, snorted, ingested, or smoked. Injected heroin gives the user the most rapid onset of euphoria in as little as 7 to 8 seconds. Although the other routes of administration have slower onset, the effects last longer. Nearly all reported heroin-related fatalities involve the injected route. As with other illegal substances, dealers dilute the heroin with other substances, which can contribute to the patient’s symptoms and make the diagnosis more difficult.



Signs and Symptoms


The classic triad of heroin use is central nervous system depression, respiratory depression, and miosis.9 Assess for any signs and symptoms of chronic abuse. These include redness and swelling of the nares and multiple scars or “track marks” in numerous locations. Drug abuse paraphernalia found among the patient’s belongings (i.e., syringes, bent spoons, bottle caps, and rubber tubing) is another indicator of heroin abuse. Heroin addicts, like all drug abusers, are susceptible to multiple infectious diseases and processes, including human immunodeficiency virus (HIV), hepatitis B and C, endocarditis, and multiple skin abscesses.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Substance Abuse

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