July 11, 2020
Gwen R. Amurao, MD
Over the past few years, there has been a serious increase in drug use and abuse all over the world. Even with the recent war against illegal drugs here in the country, it seems that there are still so many out there who turn to drug use. This problem continues to persist despite people knowing the lethal effects of drugs.
According to the Center for Disease Control and Prevention (CDC), deaths from drug overdose involving stimulants increased from 1,378 in 2007 to an overwhelming 10,333 in 2017. Currently, illicit drug use is one of the top 10 preventable risk factors for years of healthy life lost in developed counties.
In the US alone, approximately 10% of the population (12 years and older) reported current use of illicit substances, which later on became lifelong dependence on drugs. Although studies show that genetics may play a role in drug addiction, or any addiction for that matter, important factors such as one’s environment and early exposure and even neurobiology cannot be completely disqualified.
The Mayo Clinic defines drug addiction or substance use disorder, as a disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication.
Addiction often starts as an “experiment” wherein a person simply wants to try a certain drug and see what it is all about. In most, if not all of the cases, the experimental use becomes habitual, until a person finds it increasingly difficult to go through the day without the drug. Stopping its use commonly leads to intense craving and physical signs and symptoms of illness.
Screening and Diagnosis
Since most of the drug users experience signs and symptoms which may be new, early consultations with primary care physicians are commonly reported. Sadly 43% of such consults would lead to failure of diagnosis of substance abuse disorders specifically because of the generalized or non-specific manifestations of such individuals.
In any clinical setting, early detection for immediate treatment and prevention of complications is key. To be able to effectively diagnose such conditions, it is important that one is educated regarding such substances and the parameters under which suspected individuals can be classified as having the disorder.
Because drug use can start as early as the teenage years, it is important to determine whether a teenager is simply going through the hormones and moodiness that comes along with adolescence or it is something more. Some red flags include:
In reality, these observations can also be reported in adults. When consulting with a physician, a thorough medical history and physical examination will often reveal some important signs or symptoms or red flags associated with drug use.
Once suspected, urine test should be requested since it provides an immediate and inexpensive method of diagnosing drug use. However, urine samples may be easily tampered with and manipulated, hence it is not the most ideal or most reliable screening option. Urine immunoassays and liquid and gas chromatography (mass spectrometry) are often more reliable and more specific, but would take a longer time to produce results and confirm any suspicion of drug use.
The criteria in the Diagnostic and Statistical Manual of Mental Disorders or DSM5, published by the American Psychiatric Association is often used to diagnose the presence of a substance use disorder.
Knowing the Drugs
Cocaine is more commonly known as crack, coke or snow and can enter the body through different routes. It is a fine white powder which can be snorted or mixed with water and injected. Passive absorption has been reported through inhalation and can be detected in blood, urine, hair, saliva, sweat, and breast milk, which means that it can cross through the placenta and can be transferred directly to the fetus.
With its rapid onset of action and short lasting effect of less than 30 minutes when smoked or injected, users often need to administer repeated doses to maintain its desired effect. Introducing the drug intranasally or through snorting would often lead to a more lasting effect, which is why most individuals prefer to use it this way.
Immediately, a person can experience an overall feeling of euphoria or elation, with increased energy, alertness, and sociability, and can go on for hours or days without food or sleep. With increased dose and frequency of administration, a person can begin to experience psychotic symptoms such as hallucinations and paranoia.
Other common complications associated with it include vasospasm, hypertension, acute aortic dissection, acute myocardial infarction and hemorrhagic stroke, crack lungs, seizures, bruxism, and rhabdomyolisis
Methamphetamine, more commonly known as chalk, crank, crystal, glass, ice or meth is currently the most illicitly used drug in the US, and was previously used as treatment for attention-deficit/hyperactivity disorder or ADHD. Just like cocaine, it can be taken orally, intra-nasally, or through injection once dissolved in water or alcohol. Its longer duration of action regardless of its route of administration makes it more attractive to drug users.
Once inhaled or injected, the meth immediately rushes to the brain causing a euphoric rush or “flash”. Aside from this, a person can also experience the following:
Just like cocaine, repeated doses are often needed to maintain its desired effect. Because of its ability to reach and affect certain parts of the brain, it has also been associated with memory and emotion effects even after a person has stopped using it. The characteristic manifestations of long-term meth use are severe changes in appearance, severe weight loss, and dental problems such as dental caries and tooth decay, more commonly known as “meth mouth”.
MDMA or Club Drugs
MDMA or 3,4-methylenedioxymethamphetamine, more commonly known as ecstacy or X, molly or lover’s speed, is both a stimulant and a psychedelic, which induces feelings of increased energy and sensitivity to light, sound, and taste. Other commonly reported signs and symptoms include:
It is often taken orally as a pill, but can come in liquid form, and can sometimes be introduced intra-nasally. Its effects last for as long as 3 to 6 hours, but are still administered in repeated doses if one wants prolongation of its desired effects.
MDMA basically affects one’s mood and can make a person feel extremely “ecstatic,” thus its name. Although it gives that “high” in the beginning, once it crashes, severe negative and uncontrollable behavior and mood are often manifested. Since this drug is stimulatory, it also increases one’s heart rate and temperature and can make a person extremely thirsty because of its effects on the kidneys. Too much water intake will often lead to decreased sodium levels leading to serious electrolyte imbalances in the body.
Synthetic cannabinoids or compounds known as black mamba, fake weed, K2, mojo, scooby snax or spice have marijuana or cannabis properties and are sprayed onto dried, shredded herbs. Although often inhaled or smoked, it can also come in liquid forms that are vaporized or inhaled in electronic delivery devices and can even be prepared as tea. It has also been sold in incense forms all over the world.
Signs and symptoms of cannabis or synthetic cannabinoid use include:
Since it produces more intense and long-lasting effects, acute intoxication and withdrawal syndromes may require hospitalization since it may lead to heart attacks and seizures. Although cannabinoids were originally used as treatment for chronic pain syndromes, dementia such as Alzheimer’s, it has also been found to be highly addictive with severe withdrawal characteristics leading to anxiety, depression, and death.
Bath salts are the cheaper alternatives to stimulant drugs and are more commonly known as bloom, cloud nine, flakka, lunar wave, vanilla sky, and white lightning. These are known as mind-altering or psychoactive substances that are similar to MDMAs. They were once sold as white or brown crystal-like powder and were labeled as bath salts (thus the name), plant food or jewelry cleaners. Signs and symptoms associated with its use are:
It can be ingested, inhaled or snorted, and injected. Because of its severe stimulatory effects, it often leads to severe intoxication where a person is unaware of harming oneself or others and also results to death.
When managing individuals dealing with addiction, it is important that a method of intervention is carefully planned and coordinated with one’s family or loved ones, unless it is the desire of the individual to take it upon himself to be rehabilitated.
The Mayo Clinic mentions several methods of treatment, which can be helpful in those with drug use disorders. In every type of management though, dealing with withdrawal is one of the most difficult hurdles that must be overcome. In this process of detoxification, the individual should be withdrawn from the drug as quickly and as safely as possible. To avoid going into relapses during this period of withdrawal, some drug users or families of such users prefer that they be kept in a rehabilitation facility for a certain period of time.
Treatment options can vary from one person to another, and an individualized approach is always best. Individual, group or family therapy sessions are helpful as the case may be. In each therapy session, the underlying reason for addiction is vital in moving forward toward rehabilitation. Undergoing behavior therapy and taking part in support and self-help groups also help those needing treatment for their conditions.
Psychosocial therapy in those suffering from cocaine addiction showed decreased adherence and increased abstinence from the drug. Other psychosocial interventions which proved beneficial were individual and group counseling and cognitive behavior therapy. No medications have currently been approved for the treatment of disorders linked to cocaine use.
As for methamphetamine use disorder, the drug mirtazipine is currently being reviewed since early studies showed that with weekly counseling, there was reported decrease in methamphetamine use despite low adherence.
Forms of management for MDMA include behavior therapy and recovery support groups. Meanwhile, intensive intervention using cognitive therapy and motivational enhancement therapy were found to be effective in synthetic cannabinoid disorders. Presently, buspirone, gabapentin and N-acetylcysteine are being studied since they showed increased abstinence from the said drug when taken.
Behavior therapy also seems to benefit those with bath salt disorders especially when treated during the early stages of illness.
No matter what type of drug addiction or form of treatment one gets, what is important is staying persistent and committed in overcoming such a disorder, and knowing that life beyond drugs can be far more enjoyable and memorable with a clear state of mind. As physicians, it is our duty to be well informed about such drugs and to be able to detect such disorders once we are presented with them.