II. Epidemiology

  1. Prevalence (2015, U.S. over age 10 years old): 10% (>20 Million)
  2. Teenagers <14 years old who use substances will have a 33% risk of Substance Use Disorder longterm
  3. Substance use goes undiagnosed in 43% of cases in the primary care setting

III. Preparations: Primary abused substances

  1. Precautions
    1. Substances of abuse are difficult to distinguish by sight
    2. White powder could be Cocaine, Methamphetamine, synthetic Opioids, NBOMe or bath salts
    3. Crystals could be Crystal Meth, U-47700
    4. Many substances of abuse are reformulated into tablets
      1. Fentanyl may be formed in tablets similar to Oxycodone or Hydrocodone
  2. Alcohol
    1. See Alcohol Abuse
    2. Ethanol-based hand sanitizer (especially in health care centers)
      1. Hand sanitizer can cause significant Alcohol Intoxication (60% Alcohol)
      2. Some abusers of hand sanitizer extract the Alcohol with salt
  3. Cannabinoids (Marijuana, K2, Spice)
    1. See Marijuana (includes Synthetic Cannabinoids such as K2)
    2. Most common drug of abuse in U.S. and progressively increasing annually among grades 8-12
  4. Opioids (e.g. Oxycodone, Morphine, Heroin)
    1. See Opioid Abuse
    2. Dextromethorphan Abuse
  5. Sedative-Hypnotics
    1. Benzodiazepine Abuse
    2. Gamma Hydroxybutyrate (GHB)
  6. Stimulants
    1. Cocaine
    2. Methamphetamine
    3. Synthetic Cathinones (Psychoactive Bath Salts)
    4. Methylenedioxymethamphetamine (MDMA, Ecstasy)
  7. Volatile Inhalants (Sniffing, Huffing, Bagging)
    1. More common drug of abuse in ages 10-14 years old
    2. Risk of Sudden Sniffing Death Syndrome
  8. Hallucinogens
    1. Ketamine Abuse (and Methoxetamine)
    2. Phencyclidine (PCP)
  9. Other intoxicants
    1. Nitrous Oxide Abuse (Laughing Gas, Whippets)

IV. Preparations: Prescription and OTC Drug Abuse

  1. Amphetamines
  2. Benzodiazepines
  3. Opioids
  4. Dextromethorphan (used at high doses as an Opioid)
    1. See Dextromethorphan Abuse
  5. Diphenhydramine
    1. Used at high doses as a Hallucinogenic
    2. Other Anticholinergic Medications have been similarly abused (e.g. dicyclomine, Oxybutynin)
    3. Diphenhydramine Overdose also risks Seizures, coma and death

V. Preparations: Prescribed and OTC medications that potentiate Drugs of Abuse

  1. Albuterol
    1. Used to enhance effects of crack Cocaine
  2. Clonidine (Catapres)
    1. Use to prolong the effects of Heroin and other Opioids
  3. Bupropion (Wellbutrin)
    1. Crushed and snorted to induce a high ("poor man's Cocaine")
  4. Pseudoephedrine
    1. Used to synthesize Methamphetamine
  5. Quetipine (Seroquel)
    1. Used to enhance the effects of Heroin or for calming
  6. Loperamide (Imodium)
    1. Used in doses as high as 60 mg/day for Opioid effects or for Opioid Withdrawal symptoms
  7. Gabapentin (Neurontin) or Pregabalin (Lyrica)
    1. Used at high doses for Opioid effect or for withdrawal from Cocaine, Opioids, Alcohol
  8. References
    1. (2015) Presc Lett 22(10):59

VI. Definitions

  1. Chemical Intoxication
    1. Reversible substance-specific syndrome
    2. Due to recent ingestion
    3. Behavioral or psychological maladaption
  2. Hazardous Use
    1. Substance use that puts the user at risk for harmful consequences
    2. Highest risk substances: Heroin, Methamphetamine, crack Cocaine
  3. Withdrawal
    1. Substance-specific reaction to cessation of intake

VII. Diagnosis: Substance Use Disorder (DSM-5)

  1. Problematic pattern of use of intoxicating substance over a 12 month period and
    1. Not specifically otherwise classified (e.g. Alcohol, Caffeine, Cannabis, Hallucinogen, inhalant, opiod, Sedative, stimulant)
  2. Clinically Significant Impairment or distress and
  3. At least 2 of the following criteria present
    1. Consumption in larger amounts (or for longer duration) than intended
    2. Persistent desire or unsuccessful attempts to cut down or control substance use
    3. Significant time spent to obtain the substance (e.g. driving long distances between multiple prescribing doctors)
    4. Craving or a strong desire or urge to use the substance
    5. Gives up important social, occupational or recreational activities to recurrently use the substance
    6. Persistent use despite negative consequences (social, occupational, psychological, physical)
    7. Recurrent substance us in physically hazardous situations (e.g. DUI)
    8. Continued substance use despite causing or worsening physical or psychological problems
    9. Tolerance
      1. Markedly increased substance amounts needed for Intoxication or
      2. Markedly diminished effect with the same substance amount
    10. Withdrawal
      1. Characteristic withdrawal syndrome for the substance
      2. Substance is used to avoid withdrawal symptoms
  4. Qualifiers
    1. Early Remission
      1. No substance use criteria (other than craving) are met for 3-12 month period
    2. Sustained Remission
      1. No substance use criteria (other than craving) are met for >12 month period
    3. Controlled Environment
      1. Patient remains in a setting for which substance access is restricted

VIII. Resources

IX. References

  1. (2013) DSM 5 Manual, APA, Washington, D.C.
  2. (2020) Presc Lett 27(11): 61-2

Images: Related links to external sites (from Bing)

Related Studies

Ontology: AODD psychiatry (field) (C0681960)

Concepts Biomedical Occupation or Discipline (T091)
English Alcohol or Other Drug Disorder psychiatry (field), AODD psychiatry (field)

Ontology: Intoxication (C0728899)

Concepts Finding (T033)
SnomedCT 75478009, 60481001
English Intoxication, intoxications, intoxication, Intoxication, NOS
Dutch intoxicatie
French Intoxication
German Intoxikation
Italian Intossicazione
Portuguese Intoxicação
Spanish Intoxicación
Japanese 中毒, チュウドク
Czech Intoxikace
Hungarian Intoxicatio

Ontology: Substance abuse problem (C0740858)

Definition (CCC) Excessive use of harmful bodily materials
Definition (NCI_NCI-GLOSS) The use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts. Substance abuse may lead to social, physical, emotional, and job-related problems.
Definition (NCI) Maladaptive pattern of drug or alcohol use that may lead to social, occupational, psychological, or physical problems.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D019966
SnomedCT 191879007, 66214007
LNC LP36307-4, MTHU019364
English Abuse, Substance, Nondepend abuse of substance, Abuses, Substance, Substance Abuses, abuse (drug or alcohol), Alcohol or Other Drugs abuse, alcohol or other drug abuse, AOD abuse, chemical abuse, dysfunctional Alcohol or Other Drugs use, harmful Alcohol or Other Drugs use, dysfunctional AOD use, harmful AOD use, Substance abuse problem, rndx substance abuse, rndx substance abuse (diagnosis), drug and alcohol abuse, alcohol or drug abuse, Substance Abuse Problems, substance abuse (diagnosis), Harmful substance use (disorder), Substance abuse, Harmful substance use, Nondependent abuse of substance, Substance abuse (disorder), substance abuse, disorder, substance abuse, substance abuse disorder, Substance Abuse
Dutch middelenmisbruik, Middelenmisbruik
French Usage abusif de substances, Abus de substance
German Missbrauch einer Substanz, Substanzmißbrauch
Portuguese Abuso de substâncias, Abuso de Substâncias
Spanish Abuso de sustancias, Abuso de Sustancias, consumo de sustancias (trastorno), consumo de sustancias
Japanese 物質乱用, ブッシツランヨウ
Czech abúzus psychoaktivních látek, Zneužívání léku nebo návykové látky
Italian Abuso di sostanze
Hungarian Anyaggal történő visszaélés
Norwegian Stoffmisbruk

Ontology: Drug Dependence (C1510472)

Definition (NCI) Drug dependence - replaced the term "drug addiction" and is defined as a state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterized by behavioral and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present. A person may be dependent on more than one drug.
Definition (PSY) Physical and emotional dependence on a chemical substance. Compare DRUG DEPENDENCY.
Definition (PSY) Psychological craving for or habituation to the use of a chemical substance which may or may not be accompanied by physical dependency. Used for animal or human populations. Compare DRUG ADDICTION.
Definition (CSP) state of heavy dependence on any drug, including alcohol; sometimes defined as physical dependence but usually also including emotional dependence, i.e., compulsive or pathological drug use.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D019966
ICD9 304.9, 304
SnomedCT 191878004, 154909004, 192310006, 154915004, 191816009, 2403008, 6525002
LNC LA6189-0
English Dependence, Drug, Unspecified drug dependence, ADDICTION ANY DRUG, DRUG ADDICTION, DRUG DEPENDENCE, Drug Dependency, Drug dependence NOS, Drug Dependence, chemical addiction, chemical dependence, drug dependence, drug dependence (diagnosis), Drug Addiction, Addiction, Drug, Addiction any drug, Addiction to drugs, Dependence drug (NOS), Drug dependence, unspecified, Abuse;drug(s);dependent, Addiction;drug(s), Dependence;drug(s), Dependence syndrome (disorder), Drug dependence NOS (disorder), [X]Drug addiction NOS, substance abuse drug dependent, Dependent drug abuse (diagnosis), Drug dependency, Drug dependence, Dependent drug abuse, Drug addiction, Dependence syndrome, Dependent drug abuse (disorder), Drug dependence (disorder), Psychoactive substance dependence (disorder), Psychoactive substance dependence, dependence; drugs, dependence; drug, dependence; substance, drug; dependence, drugs; dependence, Psychoactive substance dependence, NOS, Drug dependence, NOS, Dependency (Drug), Chemical Dependence, Drug addiction NOS, drug addiction, drug abuse and dependency
Italian Dipendenza da droghe, Dipendenza da droghe non specificata, Farmacodipendenza, Farmacodipendenza NAS, Dipendenza da farmaci (NAS), Dipendenza, qualunque farmaco, Dipendenza da farmaci
Dutch niet-gespecificeerde drugsafhankelijkheid, drugsverslaving, drugsafhankelijkheid, niet-gespecificeerd, verslaving aan een middel, drugsafhankelijkheid (NAO), drugsafhankelijkheid NAO, afhankelijkheid; drugs, afhankelijkheid; geneesmiddel of drug, afhankelijkheid; stof, drug; afhankelijkheidssyndroom, drugs; afhankelijkheidssyndroom, drugsafhankelijkheid, Drugafhankelijkheid
French Toxicomanie, non précisée, Addiction aux drogues, Dépendance à une drogue non précisée, Dépendance aux drogues SAI, Addiction à une drogue, Toxicomanie, Pharmacodépendance, ACCOUTUMANCE AUX DROGUES, PHARMACODEPENDANCE, Dépendance pharmacomédicamenteuse
German Drogenabhaengigkeit, unspezifisch, Sucht nach Drogen, unspezifische Drogenabhaengigkeit, Sucht, beliebige Droge, Suchtdroge (NNB), Arzneimittelsucht, Drogenabhaengigkeit NNB, Arzneimittelabhängigkeit, ARZNEIMITTELABHAENGIGKEIT, ARZNEIMITTELSUCHT, MEDIKAMENTENABHAENGIGKEIT, Arzneimittelabhaengigkeit, Drogenabhängigkeit, Medikamentenabhängigkeit
Portuguese Toxicodependência NE, Fármacodependência, Dependência de qualquer droga, Dependência de drogas, Dependência de Drogas, FARMACODEPENDENCIA, HABITUACAO A QUALQUER DROGA, TOXICODEPENDENCIA, Drogadição, Farmacodepência
Spanish Dependencia de drogas no especificadas, Toxicomanía, Dependencia de drogas NEOM, Adicción a cualquier droga, Adicción a drogas, Dependencia a drogas (NEOM), Dependencia a Drogas, ADICCION A CUALQUIER FARMACO, ADICCION A FARMACOS, DEPENDENCIA DE FARMACOS, Drogadicción, drogadependencia, SAI (trastorno), drogadependencia, SAI, Drug dependence NOS, adicción a drogas, adicción a las drogas, dependencia de drogas (trastorno), dependencia de drogas, dependencia de fármacos, dependencia de sustancias psicoactivas (trastorno), dependencia de sustancias psicoactivas, dependencia de sustancias, drogadicción, toxicomanía, Dependencia de drogas, drogadependencia (trastorno), drogadependencia
Japanese 薬物依存、詳細不明, 薬物依存, 薬物依存NOS, 薬物嗜癖, 薬物依存(NOS), ヤクブツシヘキ, ヤクブツイゾンショウサイフメイ, ヤクブツイゾンNOS, ヤクブツイゾン
Czech Drogová závislost, Závislost na drogách NOS, Závislost na drogách (NOS), Závislost na drogách, Závislost na drogách, blíže neurčená, Blíže neurčená závislost na drogách, Závislost na jakékoli droze, závislost na drogách, drogová závislost
Hungarian Szer addictio, Szerfüggőség (k.m.n.), Szerfüggőség, Szer függőség k.m.n., Szer függőség, nem meghatározott, Szer függőség, Nem meghatározott szer függőség
Norwegian Rusmiddelavhengighet