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Chapter: Modern Medical Toxicology: Substance Abuse: Substances of Dependence and Abuse

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Classification - Substances of Dependence and Abuse

Modern Medical Toxicology: Substance Abuse: Substances of Dependence and Abuse

CLASSIFICATION

·              Ethanol

·              Tobacco

·              Tranquillisers and Sedatives

Barbiturates, benzodiazepines, chloral hydrate, chlorme-thiazole, ethchlorvynol, glutethimide, hexapropymate, meprobamate, methyprylon, methaqualone, zolpidem, zopiclone

·              Opiates and Opioids

·              Cocaine

·              Cannabis

·              Amphetamines and “Designer Drugs”

·              Hallucinogens

Lysergic acid diethylamide (LSD), phencyclidine, psilo-cybine, bufotenine, mescaline, ketamine, diethyltrypt-amine (DMT)

·              Inhalants

Fluorinated hydrocarbons (freons), ethers, ketones, aromatic and aliphatic hydrocarbons

·              Miscellaneous Substances Caffeine, datura seeds, analgesics, anabolic steroids, cough syrups, laxatives

Several of these compounds have been discussed in detail elsewhere, and the reader is advised to consult the Index for locating them. The remaining will be discussed inthis section.

Globally, of the various substances abused, alcohol and tobacco head the list, followed by sedatives and tranquillisers, cannabis, opiates, and cocaine. Amphetamines and hallucinogens are less popular, though newer recreational drugs (“designer drugs”) are increasingly being abused, especially by the youth. One American study found a life-time prevalence of alcoholism of 13.5%, and a life-time prevalence of other drug abuse of 6.1%. The WHO estimates that one third of the world popula-tion (15 years and above) abuses tobacco in some form or other. Currently, tobacco abuse is said to be responsible for 3.5 million deaths worldwide every year, and if the trend continues, the figure is expected to rise to 10 million deaths per year by 2020.

The most commonly abused drugs (apart from alcohol and tobacco) in India appear to be cannabis, opiates, and sedatives and tranquillisers. There are also indications of significant abuse of cocaine, hallucinogens, and “designer drugs” among the upper classes of society.

While it is a fact that many individuals experiment with drugs especially in their youth, not all become dependant on them. In fact, it is only a small proportion of susceptible individuals who go on to become addicts. Table 34.2 lists some of the factors which predispose to dependence. Medical professionals should be familiar with these risk factors which can help them to identify potential abusers and take pre-emptive action whenever possible. It is also important to be able to recognise signs and symptoms of drug abuse as well as identify clues in the form of behavioural changes which point to surreptitious abuse (Table 34.3).




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