DRUG CHARACTERISTICS

LEARNING OBJECTIVES: Describe the uses and effects of six categories of controlled substances. Describe deliriants, designer drugs, and look-alike drugs.

For this chapter, we will place drugs into six categories-narcotics, depressants, stimulants, hallucinogens, cannabis, and steroids. These

Table 7-4.-Federal Trafficking Penaltiea-Marijuana

controlled substances, their uses and effects, are outlined in table 7-5.

The MA attempting to identify capsules, tablets, and pills should consult the Product section of the Physicians Desk Reference (PDR). The PDR is a medical reference book published by the Medical Economics Company. Every MA unit should have a copy within the organization. The PDR contains true color pictures of most all legally manufactured drugs. If the MA has a capsule, tablet, or pill to identify, it may be easily and accurately compared to the photos in the PDR. The MA should bear in mind that if a capsule is being compared, the contents of that capsule may have been replaced and contain a substance other than that supplied by the manufacturer. Similarly, tablets and pills are often impregnated or "laced" with other drugs or substances by drug abusers. For this reason all pills, tablets, and capsules should be field tested.

The MA may obtain a copy of the PDR in several ways. The most common method is by obtaining a preceding year's copy from a local physician when the physician receives the current edition. Navy hospitals, normal supply channels, and the Naval Criminal Investigative Service (NCIS) are alternate sources.

NARCOTICS

The term narcotic is used to describe opium, opium-based derivatives, and synthetic substitutes. The stimulant cocaine is a narcotic by legal definition. Narcotics have been useful in the practice of medicine for relief of intense pain, since they are the most effective analgesics known. The relief they provide may be physical or psychic.

Under medical supervision, narcotics are administered orally or by intramuscular injection. As drugs of abuse, however, they maybe sniffed, smoked, or self-administered by the more direct routes of subcutaneous ("skin-popping") and intravenous ("mainlining") injection.

The relief of suffering, whether of physical or psychological origin, may result in a short-lived state of euphoria. The initial effects, however, are often unpleasant, leading many to conclude that those who persist in their illicit use may have latent personality

Table 7-5.

disturbances. Narcotics tend to induce pinpoint pupils and reduced vision, together with drowsiness, apathy, decreased physical activity, and constipation. A larger dose may induce sleep, but there is an increasing possibility of nausea, vomiting, and respiratory depression-the major toxic effect of the opiates. Except in cases of acute intoxication, there is no loss of motor coordination or slurred speech as in the case of the depressants.

To the extent that the response may be felt to be pleasurable, its intensity may be expected to increase with the amount of the dose administered. Repeated use, however, will result in increasing tolerance. The user must administer progressively larger doses to attain the desired effect, thereby reinforcing the compulsive behavior known as drug dependence.

Physical dependence refers to an alteration of the normal functions of the body that necessitates the continued presence of a drug to prevent the withdrawal or abstinence syndrome, which is characteristic of each class of addictive drug. The intensity of physical symptoms experienced during the withdrawal period is related directly to the amount of narcotic used each day. Deprivation of an addictive drug causes increased excitability of those same bodily functions that have been depressed by its habitual use.

With the deprivation of narcotics, the first withdrawal signs are usually experienced shortly before the time of the next scheduled dose. Complaints, pleas, and demands by the addict are prominent, increasing in intensity and peaking from 36 to 72 hours after the last dose, then gradually subsiding. Symptoms such as watery eyes, runny nose, yawning, and perspiration appear about 8 to 12 hours after the last dose. Thereafter, the addict may fall into a restless sleep. As the abstinence syndrome progresses, restlessness, irritability, loss of appetite, insomnia, goose flesh, tremors, and finally yawning and severe sneezing occur. These symptoms reach their peak at 48 to 72 hours. The patient is weak and depressed with nausea and vomiting. Stomach cramps and diarrhea are common. Heart rate and blood pressure are elevated. Chills alternating with flushing and excessive sweating are also characteristic symptoms. Pains in the bones and muscles of the back and extremities occur as do muscle spasms and kicking movements, which may be the source of the expression "kicking the habit." At this time, some persons may become suicidal. Without treatment, the syndrome eventually runs its course and most of the symptoms will disappear in 7 to 10 days. However, the psychological desire for the drug may never be overcome.

Since addicts tend to become preoccupied with the daily round of obtaining and taking drugs, they often neglect themselves and may suffer from malnutrition, infections, and unattended diseases or injuries. Among the hazards of narcotic addiction are toxic reactions to contaminants such as quinine, sugars, and talcum powder, as well as unsterile needles and injection techniques, resulting in abscesses, blood poisoning, and hepatitis. Since there is no simple way to determine the purity of a drug that is sold on the street, the potency is unpredictable. A person with a mild overdose may be stuporous or asleep. Larger doses may induce a coma with slow shallow respiration. The skin becomes clammy cold, the body limp, and the jaw relaxed. There is a danger that the tongue may fall back, blocking the air passageway. If the condition is sufficiently severe, convulsions may occur, followed by respiratory arrest and death.