11

Drug abuse and drug Drug abuse and drug dependencedependence

Zhou YanqiongZhou Yanqiong

22

Broad definition of Broad definition of drug abusedrug abuse::

Unreasonable administrationUnreasonable administration

（（ drug abusedrug abuse ））

33

Narrow definition ofNarrow definition of drug abuse:drug abuse:

psychological dependence psychological dependence

physiological dependencephysiological dependence

mental disordermental disorder

aberrant behavioraberrant behavior

44

definition of definition of drug dependencedrug dependence

UnusualUnusual mental state mental state

ConstraintConstraint

Continuity or regularityContinuity or regularity

mental effectmental effect

to avoid malaiseto avoid malaise

tolerationtoleration

55

Key Concepts and TermsKey Concepts and Terms

physical dependence/ physiological physical dependence/ physiological dependencedependence

psychic dependence/ psychological psychic dependence/ psychological dependencedependence

cross-dependencecross-dependence

66

poppy flower of California (1998.5)poppy flower of California (1998.5)

77

opium opium poppypoppy

88

marijuanamarijuana

99

drug tolerancedrug tolerance

DefinitionDefinitionRepeatRepeated ed medicationmedication

CharacteristicCharacteristicDifferent toleranceDifferent toleranceReversabilityReversabilityCross resistance :Cross resistance :

analogic chemcial constitutionanalogic chemcial constitution mechanism of actionmechanism of action

drug dependencedrug dependence toleration toleration

1010

Classification of Classification of drugdrug to causeto cause depe dependencendence

narcotic drugnarcotic drug

psychotropic drugpsychotropic drug

1111

Narcotic drugNarcotic drug

Consecutive application to bring about phConsecutive application to bring about physiological dependence and addictionysiological dependence and addiction

Including:Including:

opioids, cocaine, cannabisopioids, cocaine, cannabis

1212

psychotropic drugpsychotropic drug

DefinitionDefinitionRepeatRepeated ed medication, medication, AffectAffect C.N.SC.N.S excited/inhibited excited/inhibitedto bring about psychological dependenceto bring about psychological dependence

（（ 11 ） ） Sedativehypnotics / antianxietic:Sedativehypnotics / antianxietic:Barbiturates, benzodiazepinesBarbiturates, benzodiazepines（（ 22 ） ） psychostimulant psychostimulant ： ： Amphetamines,Amphetamines, ritalin, caffeineritalin, caffeine（（ 33 ）） psychodelic psychodelic ：：Cannabinol, cannabidiolCannabinol, cannabidiol

1313

WHO classificationWHO classificationSuppressant of central nerveSuppressant of central nerve

Nicotine or tobaccoNicotine or tobacco

OpioidOpioid

antimelancholicantimelancholic

cannabiscannabis

hallucinogenic drughallucinogenic drug

FugitiveFugitive compound compound

1414

AppearanceAppearance of drug dependence of drug dependence

Craving re-medicationCraving re-medication

Constraint drug seeking behaviorConstraint drug seeking behavior

Withdrawal reactionWithdrawal reaction

1515

CharacteristicCharacteristic of drug dependen of drug dependencece

OpioidOpioiddiscontinuation 8-16h, 24-36hdiscontinuation 8-16h, 24-36h

Suppressant of central nerveSuppressant of central nerveBenzodiazepine withdrawal 36hBenzodiazepine withdrawal 36hBarbiturates withdrawal 12-24h Barbiturates withdrawal 12-24h

Cannabis Cannabis AntimelancholicAntimelancholic#phenamine#phenamine#Cocaine #Cocaine

1616

DisserviceDisservice of drug abuse of drug abuse

IndividualIndividualphysical and mental healthphysical and mental healthIntoxation deathIntoxation deathimmunity infectionimmunity infection

SocietySocietyCommonCommon family life destroy family life destroyCriminalityCriminalityhold-back developmenthold-back development

1717

Control of drug abuseControl of drug abuse

InternationalInternational19611961 convention convention19711971 convention convention1981 1981 strategystrategyNationalNationalinstitute systeminstitute systemEducationEducationmedical establishment of withdrawalmedical establishment of withdrawal

1818

prevention and cureprevention and cure

Insulate to withdrawalSubstitution therapyBarbiturates ： PhenobarbitalAlcohol ： clormethiazole ； clorazepateOpioid ： methadone ；

1919

Substitution therapy of methadoneSubstitution therapy of methadone

pharmacologic action ofpharmacologic action of methadone methadone

methadonemethadone 1mg 1mg

morphine morphine 4mg; 4mg; heroin heroin 2mg; 2mg; dolantin dolantin 20mg20mg

①① detoxificationdetoxification

②②convalescent careconvalescent care

replace

2020

Therapy of clonidineTherapy of clonidine

pharmacologic action of clonidine:pharmacologic action of clonidine:

ExcitomotorExcitomotor of ofα2 α2 adrenoceptoradrenoceptor

Inhibit Inhibit NC NC excitationexcitation of of NENE nucleus ceruleu nucleus ceruleuss

to controlto control abstinent symptom abstinent symptom

therapytherapy

①① detoxificationdetoxification

②②convalescent careconvalescent care

2121

TherapyTherapy of the drug abuse of the drug abuse

DetoxificationDetoxification

to prevent to prevent relapserelapse

ReturnReturn to to social lifesocial life

2222

ChronopharmacologyChronopharmacology

Definition of chronopharmacologyDefinition of chronopharmacology

Definition of BioperiodicityDefinition of Bioperiodicity

Definition of circadianDefinition of circadian

Definition of circannual rhythmDefinition of circannual rhythm

E=E=κ•κ• F(F(αα,C,S,C,S))

2323

oral administration effectoral administration effect::Pharmaceutics;Pharmaceutics;

pharmacokineticspharmacokinetics

pharmacodynamicspharmacodynamics

pharmacotherapeuticspharmacotherapeutics

ChronopharmacokineticsChronopharmacokinetics

ChronopharmacodynamicsChronopharmacodynamics

2424

RhythmicityRhythmicity and pharmacokinetics and pharmacokinetics

RhythmicityRhythmicity and and drug absorptiondrug absorption

DiazepamDiazepam

TheophyllineTheophylline

amitriptylineamitriptyline

RhythmicityRhythmicity and and drug disposition, protein bdrug disposition, protein bindinginding

Diazepam protein binding 99%Diazepam protein binding 99%

2525

RhythmicityRhythmicity and pharmacokinetics and pharmacokinetics

RhythmicityRhythmicity and drug metabolism and drug metabolismMethexenyl metabolic enzymeMethexenyl metabolic enzyme

RhythmicityRhythmicity and drug excretion and drug excretionurinary volumeurinary volume ： ： cidomycincidomycin

urinary pHurinary pH ：： sulfacetic acidsulfacetic acid

RhythmicityRhythmicity and repeat administration and repeat administration

2626

RhythmicityRhythmicity and pharmacodynamics and pharmacodynamics

RhythmicityRhythmicity and drug and drug effecteffect

HMG-CoA reductase inhibitorHMG-CoA reductase inhibitor ：：PravastatinPravastatin 、、 lovastatin lovastatin

Avoiding hypotensive drug or diuretic at beAvoiding hypotensive drug or diuretic at bedtimedtime

2727

Chronopharmacology in-service use

ChronotherapyChronotherapy

ChronotherapeuticChronotherapeutic

cardiovascular drugs:Nifedipine day-night rhythm myocardial ischemia

2828

Cardiovascular drugs

Acenterine prevent :

myocardial infarction,

Cardiogenic sudden death

2929

Cardiovascular drugs

Antihypertensive ：labetalol

nifedipine

verapamil

3030

Antasthmatic

Terbutaline ： 5mg 8Am5mg 8Am ， ， 10mg 8Pm10mg 8Pm

Salbutamol retard tablets ： POHS

Theophylline ： 250mg 8Am50mg 8Am ， ， 500mg 8Pm500mg 8Pm

3131

Glucocorticoid and insulinum

adrenal cortical hormone

88 ～～ 10 Am 10 Am ： 450nmol/L450nmol/L4Pm 4Pm ： 110nmol/L110nmol/L

alternate day therapy ： Prednisonum ， prednisolone

day-night rhythmday-night rhythmobvious

3232

Antitumor drug

reproductive cycle of the tumour cell

Cyclophosphamide:VESP

Cisplatin :man.pr

Adriamycin:12Am

Arabinosylcytosin: sinusoidal administration

3333

RhythmicityRhythmicity and and Drug toxicity

Theophylline ：Strophanral

Phenobarbital

E600 （ paraoxon ）