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Transcript of Subtance Abused
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Subtance abused
psikotropika dan narkotika
Prof. Moch Aris Widodo PhD
PPD UNISMA
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PSIKOTROPIKA
DEPRESANT
STIMULANT
ALKOHOL
HALUCINOGENNARCOTIKA
MARIHUANA / GANJA
COBA COBARECREATIONAL
PENGOBATAN
DIPAKSA
ADAPTASI SEL NEURON
TOLERANCE
KEMATIAN SEL NEURON
DEGENERASI NEURON
AKUT KEMATIAN
KETERGANTUNGAN
FISIK PSIKIS
ADDICTION
WITHDRAWL SYMPTOM
STRESS
BROKEN HOME
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Penggunaan obat psikotropika dan narkotika
Menyebabkan keracunan akut pda dosis berlebihan
Gangguan pada fungsi CNS dan Fungsi kardio vasculer
Dengan gejala gejala sesuai dengan siat psikotropika / narcotika
Menyebabkan kematian
Penggunaan psikotropika dan narcotika
Tolerance addiction / dependenceWithdrawal symptom
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drugs user
environment
Drug
Abuser
addict
ADDIKSI TERHADAP OBAT ADALAH PENGGUNAAN OBAT YANG
BERULANG, PENGGUNAAN OBAT MENJADI PRIORITAS UTAMA DIATAS
KEPENTINGAN YANG LAIN , TANPA MENGHIRAUKAN EFEK NEGATIF OBAT
TERSEBUT,DAN LEBIH MEMENTINGKAN MENGKONSUMSI OBAT
DIBANDINGKAN KEPERLUAN YANG LAIN
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CRITERIA FOR DRUG DEPENDENCE/ ADDICTION
Primary criteiahighly controled or compulsive use
psychoactive effect
drug reinforced behavioor
Additional criteria
addictive behavior often involvesstereotypical pattern of use
used depite harmful effects
relaps following abstinence
recurrent drug cravings
Dependence producing drug often produce
tolerancephysical dependence
pleasant euphorian effects
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Agent (Drug) Variables.Obat psikotropika bervariasi dalam menyebabkan efek euphoria, obat
yang menyebabkan perasaan menyenangkan bagi pengguna sering kali
digunakan secara berulang ulang.
REINFORCEMENT adalah kemampuan suatu obat untuk keinginan
untuk menggunakan kembali obat tersebut. Semakin kuat reinforcmentsuatu obat semakin sering disalah gunakan.
Sifat reinforceent ini terjadi oleh karena kemamuan obat untuk
meningkatkan aktivitas neuron pada daerah otak tertentu
Cocaine, amphetamine, ethanol, opioids, cannabinoids, and nicotinesemuanya menyebabkan peningkatan kadar dopamine pada ventral
striatum terutama pada daerah nucleus nucleus accumbens
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HOST USER
TERDAPAT VARIASI RESPON PENGGUNA OBAT OBAT
PSIKOTROPIKA DAN NARKOTIKA
RESPON BERBEDA WALAU DOSIS YANG DIGUNAKAN SAMA
HAL INI OLEH KARENAKADAR OBAT DALAM PLASMA BERBEDA
ADA POLIMORPHISME DARI GEN YANG MENGKODE
ENZIM YANG TERLIBAT DALAM
ABSORBSI,METABOLISM DAN EKRESI
RESPON AKIBAT IKATAN OBAT DENGAN RESEPTOR
TOLERANCEPENGALAMAN PENGGUNAAN YANG MENYENAGKAN PADA
PERISTIWA TERTENTU SPRTIMEROKOK SETELAH MAKAN
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Environmental Var iables.
Awal penggunaan dan penggunaan secara illegal selanjutnya sangat
dipengaruhi oleh lingkungan dimana pengguna berada. Penggunan
awal obat nampaknya sebagai upaya melawan keteraturan,
dipengaruhi olehperubahan norma sosial, atau akibat tekanan
Pada suatu communitas pengguna obat psikotropik dan narkotik
dianggap sebagai orang sukses dan sebagai panutan yang dihormati,
oleh masyarakatnya terutama pemuda edukasi rendah dan tanpa
pekerjaan.
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TOLERANCE
Respon yang terjadi pada penggunaan obat psikotropika /
narcotica secara berualng ulang adalah efek yang semakin berkurang
untuk mendapatkan efek yang sama diperlukan dosis yang meningkat
atau menggunakan obat sejenis yang lebih kuat atau obat lain yang
efeknya lebih poten
Contoh adalah diazepam pada awalnya dengan dosis 5-10mg memberikan
efek sedasi ketenangan , namun apabila dilakukan dosis yang berulang
efek yang dihasilkan berkurang dibutukan ratusan mg untuk mendapatkan
efek yang sama bahkan ada pengguna diazepam yang membutuhkan
lebih 1000 mg / hari
Tolerance terjadi lebih cepat untuk obat yang menyebabkan euphoria
seperti heroin, sebaliknya tolerance pada efek opiate pada
gastrointestinal terjadi lebih lambat. Emikian pula tolerance terhadap
fungsi vital seperti tekanan darah dan pernapasan terjadi lebih lambat.,
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TOLERANCE
UNTUK MENDAPATKAN EFEK YANG SAMA DIBUTUHKAN
DOSI YANG LEBIH BESARINNATE TOLERANCE
TOLERANCE YANG SECARA GENETIK DITURUNKAN
ACQUIRED TOLERANCE
PARMAKOKINETIK : TOLERANCE OK PERUBAHAN ABSORBSI,
METABOLISM, DAN EKSKRESI OBAT
PHARMACODYNAMIC : TOLERNCE YANG TERJADI OLEHKARENA PERUBAHAN RESEPTOR /KEPADATANNYA
LEARNED TOLERANCE: TOLERANCE YANG TERJADI AKIBAT
MEKANISME KOMPENSASI FISIOLOGIS AKIBAT
PEGALAMAN EFEK OBAT YANG LALU
CROS TOLERANCE: TOLERANCE TERHADAP SUATU OBAT JUGA TER
JADI PADA PENGGUNAAN OBAT YANG LAINACUTE TOLRANCE : TOLERANCE YANG TERJADI SANGAT SINGKAT,
DALAM BEBERAPA JAM PENGGUNAAN
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Physical Dependence
Suatu keadaan yang berkembang akibat proses adaptasi neuron dan perubahan
homeostasis /terjadi homeostasis yang baru karena penggunaan obat
psikotropika atau narcotika yang berulang.
Akibat adanya obat tersebut terjadi keseimbangan baru bebagai sistem dalam
tubuh, untuk mempertahankan sistem baru tersebut diperlukan stimulasi dari obattersebut .
Apabila penggunaan obat tersebut dihentikan mendadak akan terjadi ketidak
seimbangan sistem akan berupaya untuk membentuk keseimbangan baru tanpa
obat dan ini sering menimbulkan ketidak nyamanan
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Adiksi terhadap suatu obat
neuroadaptation
Peggunaan terhenti
Proses maladaptive
Timbul gejala withdrawal
Gejala sebaliknya dari efek obat
Narcotika
Agitasi, eksitasi, alkoholDehidrasi, nyeri hebat narkotik
kematian
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Penduduk pegunungan andes di amerika selatan, menguyah daun coca
untukmendapatkan efek meningkatkan stamina namun jarang terjadi
penyalah gunaan dan ketergantungan oleh karena mengunyah daun kokapenyerapan lambat, kadar cocain dalam darah secara pelan pelan
meningkat demikian pula dengan kadar cocain diotak.
Pada akhir abad 19 ilmuwan mengisolasi cocain hydrochlorida dari daun
coca, pembuatan ektract cocain secara besar besaran serbuk kokain
dapat digunakan dengan menelan, penyerapan melalui mukosa hidung,penyuntikan inravena menyebabkan kadar cocain dengan cepat
meningkat didarah dan diotak sehingga terjadi efek stimulasi,dan semakin
menybabkan terjadinya ddiction.
CRACK COCAIN ADALAH ALKALOID KOKAIN DALAM BENTUK BASA
BEBAS, YANG HARGANYA MURAH DAN DIGUNAKAN DENGANMEGHIRUP UAPNYA (SETELAH DICAMPUR AIR PANAS ) SAMA CARA
PEMAKAIANNYA DENGAN NICOTIN DAN MARHUANA
Penyalahgunaan obat tergantung pada kecepatan peningkatan kadar obat
Di otak misalnya COCAINE
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Withdrawal Syndrome.
sinderoma yang taerjadi akibat pemutusan obat
merupakan bukti adanya phsical depndence
terjadi akibat tidak digunakannya obat
proses hyperarosal akibat readaptasi neuron
Withdrawal symptoms are characteristic for a given category of drugs and
tend to be opposite to the original effects produced by the drug before
tolerance developed.
Thus, abrupt termination of a drug (such as an opioid agonist) that
produces miotic (constricted) pupils and slow heart rate will produce a
withdrawal syndrome including dilated pupils and tachycardia.
Tolerance, physical dependence, and withdrawal are all biological
phenomena
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OBAT YANG MENDEPRESI CNS
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Ethanol.
More than 90% of American adults report experience with ethanol (commonly
called alcohol), and approximately 70% report some level of current use. Thelifetime prevalence of alcohol abuse and alcohol addiction (alcoholism) in this
society is 5% to 10% for men and 3% to 5% for women.
Ethanol is classed as a depressant because it indeed produces sedation and
sleep. However, the initial effects of alcohol, particularly at lower doses, often are
perceived as stimulation owing to a suppression of inhibitory systems
Alcohol impairs recent memory and, in high doses, produces the phenomenon of
"blackouts," after which the drinker has no memory of his or her behavior while
intoxicated. The effects of alcohol on memory are unclear, but evidence suggests
that reports from patients about their reasons for drinking and their behavior
during a binge are not reliable.
Alcohol dependent persons often say that they drink to relieve anxiety or
depression. When allowed to drink under observation, however, alcoholics
typically become more dysphoric as drinking continues thus not supporting the
idea that alcoholics drink to relieve ANXIETY
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Benzodiazepines.
Banyak diresekan digunakan secara luas jarang disalah gunakan obat
ini digunakan untuk mengobati anxiety dan insomnia
Benzodiazepin onset cepat adalah diazepam, alphrazepam
Penggunaan bebrapminggu jarang menyebabkan tolerance dan tidak
sulit menghentikan obat
Penggunaan beberapa bulan menyebabkan tolerance penghentuian
obat menyebabkan gejala withdrawal
Penderita dengan riwayat penyalah gunaan obat tau pengguna alkohol
meningkatkan kemungkinan penyalah gunan obat ini
Penyalahguna obat ini sring mengkmbinasikan dengan obat lain untuk
meningkatkan efek misalnya menggunakan menggunakan diazepam 30
menit sebelum methadone meningkatkan efek HIGH yang tidak dapat
diperoleh dengan menggnakan obat sendiri sendiri.
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Nicotine
menyebabkan ketergantungan dibuktikan walaupun 80% ingin berhenti
merokok namun tidak berhasil
Cigarette (nicotine) :addiksi tergantung pada beberapa variabel. Nikotin
menyebabkan reinforcment, seperti penggunaan cocain atau
amphetamin walaupun derajat rendah.
satu hiasapan menyebabkan reinforcment. Dengan 10 hisapan /rokok
dan 1 pak perhari menyebabkan reinforcment meningkat 200
Nicotine mempunyai efek stimulant dan depresant , pengguna
merasakan adanya keaspadaan dan relaksasi otot , nicotine
mengaktifkan nukleus accumben sistem reward di otak meningkatkan
dopamin ekstra sel, nikotin juga menyebabkan pelepasan opioid
endogen dan glukokortikoid..
There is evidence for tolerance to the subjective effects of nicotine.
Smokers typically report that the first cigarette of the day after a night of
abstinence gives the "best" feeling.
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OPIOID
MORPHINHEROIN
METHADONE
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Opioids
Opioid drugs are used primarily for the treatment of pain Some of the CNS
mechanisms that reduce the perception of pain also produce a state of well-
being or euphoria. Thus opioid drugs also are taken outside medicalchannels for the purpose of obtaining the effects on mood.
the standard medications for severe pain remain the derivatives of the opium
poppy (opiates) and synthetic drugs that activate the same receptors
(opioids). for acute pain and for severe chronic pain, the opioid drugs are
most effective. The subjective effects of opioid drugs are useful in the
management of acute pain. This is particularly true in high-anxiety situations,such as the crushing chest pain of myocardial infarction, when the relaxing,
anxiolytic effects complement the analgesia. Normal volunteers with no pain
given opioids in the laboratory may report the effects as unpleasant because
of side effects such as nausea, vomiting, and sedation. Patients with pain
rarely develop abuse or addiction problems. Of course, patients receiving
opioids over time develop tolerance routinely, and if the medication isstopped abruptly, they will show the signs of an opioid-withdrawal syndrome,
the evidence for physical dependence.
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Heroin is the most important opiate that is abused. There is no legal supply of
heroin for clinical use in the United States. Despite claims that heroin hasunique analgesic properties for the treatment of severe pain, double-blind trials
have found it to be no more effective than hydromorphone
Previously, street heroin in the United States was highly diluted: Each 100-mg
bag of powder had only about 4 mg heroin (range 0 to 8 mg), and the rest was
filler such as quinine. In the mid-1990s, street heroin reached 45% to 75%purity in many large cities, with some samples testing as high as 90%. This
means that the level of physical dependence among heroin addicts is relatively
high and that users who interrupt regular dosing will develop more severe
withdrawal symptoms.
Whereas heroin previously required intravenous injection, the more potent
supplies can be smoked or administered nasally (snorted), thus making the
initiation of heroin use accessible to people who would not insert a needle into
their veins.
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STIMULANT
COCAIN
AMPHETAMINECTACY
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Cocaine.. The number of frequent users (at least weekly) has remained
steady since 1991 at about 640,000. Not all users become addicts. A key
factor is the widespread availability of relatively inexpensive cocaine in the
alkaloidal form (free base, "crack") suitable for smoking and the
hydrochloride powder form suitable for nasal or intravenous use..
The reinforcing effects of cocaine and cocaine analogs correlate best with
their effectiveness in blocking the transporter that recovers dopamine from
the synapse. This leads to increased dopamine concentrations at critical
brain sites (However, cocaine also blocks both norepinephrine (NE) and
serotonin (5-HT) reuptake, and chronic use of cocaine produces changes inthese neurotransmitter systems, as measured by reductions in the
neurotransmitter metabolites 3-methoxy-4 hydroxyphenethyleneglycol
(MOPEG or MHPG) and 5-hydroxyindoleacetic acid (5-HIAA).
Cocaine produces a dose-dependent increase in heart rate and blood
pressure accompanied by increased arousal, improved performance on
tasks of vigilance and alertness, and a sense of self-confidence and well-
being. Higher doses produce euphoria, which has a brief duration and often
is followed by a desire for more drug. Involuntary motor activity, stereotyped
behavior, and paranoia may occur after repeated doses. Irritability and
increased risk of violence are found among heavy chronic users.
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Amphetamine and Related Agents.
amphetamine, dextroamphetam ine, methamph etam ine, phenmetrazine,
methy lphenidate, and diethy lpropion.
Amphetamines increase synaptic dopamine primarily by stimulating
presynaptic release
Intravenous or smoked methamphetamine produces an
abuse/dependence syndrome similar to that of cocaine, although clinical
deterioration may progress more rapidly. In animal studies,
methamphetamine in doses comparable with those used by human
abusers produces neurotoxic effects in dopamine and serotonin neurons.
Methamphetamine, a widely available nonprescription stimulant. Oralstimulants, such as those prescribed in a weight-reduction program, have
short-term efficacy because of tolerance development. Only a small
proportion of patients introduced to these appetite suppressants
subsequently exhibits dose escalation or drug seeking from various
physicians; such patients may meet diagnostic criteria for abuse or
addiction.Fenf luramineand pheny lpropanolamine, manzidol reduce appetite with
no evidence of significant abuse potential..
Khatis a plant material widely chewed in East Africa and Yemen for its
stimulant properties; these are due to the alkaloidal cath inone, a
compound similar to amphetamine
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MDMA ("Ecstasy") and MDA.
MDMA and MDA are phenylethylamines that have stimulant as well as
psychedelic effects. MDMA became popular during the 1980s on college
campuses because of testimonials that it enhances insight and self-knowledge.
It was recommended by some psychotherapists as an aid to the process of
therapy, although no controlled data exist to support this contention. Acute
effects are dose-dependent and include feelings of energy, altered sense of
time, and pleasant sensory experiences with enhanced perception. Negative
effects include tachycardia, dry mouth, jaw clenching, and muscle aches. At
higher doses, visual hallucinations, agitation, hyperthermia, and panic attackshave been reported. A typical oral dose is one or two 100-mg tablets and lasts 3
to 6 hours, although dosage and potency of street samples are variable
(approximately 100 mg per tablet).
MDA and MDMA produce degeneration of serotonergic nerve cells and
axons in rats. While nerve degeneration has not been demonstrated inhuman beings, the cerebrospinal fluid of chronic MDMA users has been
found to have low levels of serotonin metabolites Thus, there is possible
neurotoxicity with no evidence that the claimed benefits of MDMA actually
occur.
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Caffeine.
Caffeine, a mild stimulant, is the most widely used psychoactive drug in the
world. It is present in soft drinks, coffee, tea, cocoa, chocolate, and numerous
prescription and over-the-counter drugs.
It mildly increases norepinephrine and dopamine release and enhances neural
activity in numerous brain areas. Caffeine is absorbed from the digestive tract
and is distributed rapidly throughout all tissues and easily crosses the placental
barrier Many of caffeine's effects are believed to occur by means of competitive
antagonism at adenosine receptors. Adenosine is a neuromodulator that
influences a number of functions in the CNS The mild sedating effects that occur
when adenosine activates particular adenosine-receptor subtypes can beantagonized by caffeine.
Tolerance occurs rapidly to the stimulating effects of caffeine. Thus a mild
withdrawal syndrome has been produced in controlled studies by abrupt
cessation of as little as one to two cups of coffee per day.
Caffeine withdrawal consists of feelings of fatigue and sedation. With higherdoses, headaches and nausea have been reported during withdrawal; vomiting
is rare
Although a withdrawal syndrome can be demonstrated, few caffeine users
report loss of control of caffeine intake or significant difficulty in reducing
or stopping caffeine, if desired Thus, caffeine is not listed in the category
of addicting stimulants
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MARIHUANA
GANJA
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Cannabinoids (Marijuana)
The cannabis plant has been cultivated for centuries both for the production of
hemp fiber and for its presumed medicinal and psychoactive properties. The
smoke from burning cannabis contains many chemicals, including 61 different
cannabinoids that have been identified. One of these, D-9-tetrahydrocannabinol
(D-9-THC), produces most of the characteristic pharmacological effects of
smoked marijuana.
Surveys have shown that marijuana is the most commonly used illegal drug inthe United States. Usage peaked during the late 1970s, when about 60% of
high school seniors reported having used marijuana, and nearly 11% reported
daily use.
This declined steadily among high school seniors to about 40% reporting some
use during their lifetime and 2% reporting daily use in the mid-1990s, followedby a gradual increase to 48% of 12th graders in 2002 reporting some use.
Surveys among high school seniors tend to underestimate drug use because
school dropouts are not surveyed.
I t i ti ith ij d h i d ti d
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Intoxication with marijuana produces changes in mood, perception, and
motivation, but the effect sought after by most users is the "high" and
"mellowing out." This effect is described as different from the stimulant high
and the opiate high. The effects vary with dose, but the typical marijuana
smoker experiences a high that lasts about 2 hours. During this time, there
is impairment of cognitive functions, perception, reaction time, learning, andmemory. Impairments of coordination and tracking behavior have been
reported to persist for several hours beyond the perception of the high.
These impairments have obvious implications for the operation of a motor
vehicle and performance in the workplace or at school.
Marijuana also produces complex behavioral changes such as giddinessand increased hunger. There are unsubstantiated claims of increased
pleasure from sex and increased insight during a marijuana high.
Unpleasant reactions such as panic or hallucinations and even acute
psychosis may occur; several surveys indicate that 50% to 60% of
marijuana users have reported at least one anxiety experience. These
reactions are seen commonly with higher doses and with oral ingestionrather than smoked marijuana because smoking permits the regulation of
dose according to the effects. While there is no convincing evidence that
marijuana can produce a lasting schizophrenia-like syndrome, there are
numerous clinical reports that marijuana use can precipitate a recurrence in
people with a history of schizophrenia.
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LSD = LYSERGIC ACID DIETHYLAMIDE
LSD
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LSD
A "bad trip" usually consists of severe anxiety, although at times it is marked by
intense depression and suicidal thoughts. Visual disturbances usually are
prominent. The bad trip from LSD may be difficult to distinguish from reactions
to anticholinergic drugs and phencyclidine. There are no documented toxic
fatalities from LSD use, but fatal accidents and suicides have occurred during
or shortly after intoxication. Prolonged psychotic reactions lasting 2 days or
more may occur after the ingestion of a hallucinogen. Schizophrenic episodes
may be precipitated in susceptible individuals, and there is some evidence that
chronic use of these drugs is associated with the development of persistent
psychotic disorders
A "bad trip" usually consists of severe anxiety, although at times it is marked
by intense depression and suicidal thoughts. Visual disturbances usually are
prominent. The bad trip from LSD may be difficult to distinguish from
reactions to anticholinergic drugs and phencyclidine. There are no
documented toxic fatalities from LSD use, but fatal accidents and suicideshave occurred during or shortly after intoxication. Prolonged psychotic
reactions lasting 2 days or more may occur after the ingestion of a
hallucinogen. Schizophrenic episodes may be precipitated in susceptible
individuals, and there is some evidence that chronic use of these drugs is
associated with the development of persistent psychotic disorders
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Phencyclidine (Pcp).
PCP deserves special mention because of its widespread availability and
because its pharmacological effects are different from those of the psychedelics
such as LSD.PCP was developed originally as an anesthetic in the 1950s and later was
abandoned because of a high frequency of postoperative delirium with
hallucinations.
PCP became a drug of abuse in the 1970s, first in an oral form and then in a
smoked version enabling a better regulation of the dose.
As little as 50 mg/kg produces emotional withdrawal, concrete thinking, andbizarre responses to projective testing. Catatonic posturing also is produced and
resembles that of schizophrenia.
Abusers taking higher doses may appear to be reacting to hallucinations and
exhibit hostile or assaultive behavior.
Anesthetic effects increase with dosage; stupor or coma may occur with
muscular rigidity, rhabdomyolysis, and hyperthermia.Intoxicated patients in the emergency room may progress from aggressive
behavior to coma, with elevated blood pressure and enlarged nonreactive
pupils.
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Inhalants
Abused inhalants consist of many different categories of chemicals that are
volatile at room temperature and produce abrupt changes in mental statewhen inhaled. Examples include toluene (from model airplane glue),
kerosene, gasoline, carbon tetrachloride, amyl nitrite, and nitrous
oxide).
There are characteristic patterns of response for each substance. Solvents
such as toluene typically are used by children. The material usually is placed
in a plastic bag and the vapors inhaled. After several minutes of inhalation,dizziness and intoxication occur.
Aerosol sprays containing fluorocarbon propellants are another source of
solvent intoxication. Prolonged exposure or daily use may result in damage
to several organ systems.
Clinical problems include cardiac arrhythmias, bone marrow depression,
cerebral degeneration, and damage to liver, kidney, and peripheral nerves.Death occasionally has been attributed to inhalant abuse, probably via the
mechanism of cardiac arrhythmias, especially accompanying exercise or
upper airway obstruction.