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SOURCE

Source: Doering PL, Li RM. Substance-related disorders I: overview and depressants, stimulants, and hallucinogens. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. https://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146064131. Accessed September 25, 2018.

DEFINITION

  • The Liaison Committee on Pain and Addiction, a collaborative effort of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine (ASAM), developed definitions related to the use of medications for the treatment of pain consistent with current understanding of relevant neurobiology, pharmacology, and appropriate clinical practice.

  • Substance-related disorders include disorders of

    • Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following five Cs: chronicity, impaired control over drug use, compulsive use, continued use despite harm, and craving

    • Drug abuse is a maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance.

    • Physical dependence is a state of adaptation that is manifested by a drug class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

    • Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

PATHOPHYSIOLOGY

  • Physiologic and psychologic effects of amphetamines and other stimulants are qualitatively similar to those of cocaine.

    • Diminish fatigue

    • Increase alertness

    • Suppress appetite

  • Amphetamines increase the activity of catecholamine neurotransmitters (eg, norepinephrine and dopamine) by increased release and inhibiting the degradative enzyme monoamine oxidase.

  • Methamphetamine is used orally, intranasally, rectally, by intravenous injection, and by smoking.

  • Immediately after inhalation or intravenous injection, the methamphetamine user experiences an intense sensations, called a “rush” or “flash” that lasts only a few minutes and is described as extremely pleasurable.

  • Effect is almost instantaneous when smoked or injected.

  • Effect takes 5 min after snorting or 20 min after oral ingestion.

EPIDEMIOLOGY

  • In 2014, an estimated 27.0 million Americans aged 12 or older were current (past month) illicit drug users, meaning that they had used an illicit drug during the month prior to the survey interview. This corresponds to about 1 in 10 Americans (10.2%).

  • An estimated 6.5 million people reported nonmedical use of psychotherapeutic drugs in the past month, including 4.3 million nonmedical users of prescription pain relievers.

  • Approximately 21.5 million people aged 12 or older in 2014 had a substance use disorder (SUD) in the past year, including 17.0 million people with an alcohol use disorder, 7.1 million with an illicit drug use disorder, and 2.6 million who had both an alcohol use and an illicit drug use ...

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