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8/15/2019 cursadictiiML3.ppt
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TULBURARI LEGATE DE
UTILIZAREA
SUBSTANTELORPSIHOACTIVE
8/15/2019 cursadictiiML3.ppt
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CANNABIS
• Marihuana, hasis
• Se exra!e "in# $ane%a in"iana &Canna'is
sai(a ) Canna'is in"i$a*
• Tari +ari $ui(a-are# Mar-$, A.!anisan,
Pa/isan, 0a1ahsan, C-u+'ia, Mexi$, Ni!eria
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• Canabinoizii sun $-+%-nene $hi+i$e
exisene in %ana, $u "i(erse a$iuni asu%ra
SNC
2 Pese 34 "e i%uri
2 Ce +ai i+%-ran $-+%us#
"ea 56erahi"r-$anna'in- &THC*
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• S6a i"eni.i$a un re$e%-r s%e$i.i$ 6
$-n$enrare +are in !an!i-nii 'a1ai,hi%-$a+%, $ere'e
• Crese sine1a "e n-re%ine.rina, "-%a+ina siser--nina
• Si+uea1a ei'erarea "e "-%a+ina siurn-(eru GABA
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• Ce +ai ras%an"i "r-!
2 744 +i8 $-nsu+a-ri $-nsani, a ni(e !-'a
2 9: "in %-%uaia !-'uui a in$er$a $e %uin -
"aa
• Marijuana &;<-in=, ;!rass=, ;>ee"=, ;%-=,
;%u..=*
• C-nsu+ %rin .u+a
6
i!ari ari1anae $e$-nin 4,?6@! "e +aerie (e!eaa
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• -are ras%an"i inre %a$ienii %sihiari$i 2 in s%e$ia $ei $u s$hi1-.renie
• A!ra(ea1a e(-uia -ri$arei '-i %sihi$e
• Su"iie 2 %-ae %re$i%ia a%ariia unei S0 a
inerii $-nsu+a-ri &a"-es$eni*
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• Hasisul &- re1in*
2 Ese se$reaa "e $are %ana $a un in(eis "e
%r-e$ie a in.u-res$ene-r si .run1e-ri+%-ri(a se$eei
2 Se re$-ea1a %rin ra$are "e %e su%ra.aa
%anei 2 Cu-are ne!ru6+ar-niu
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• In re$u era .--si $a %-ena-r aa!resi(iaii
2 Ei+--!ia $u(anuui asasin# haiini &se$8III, s-"ai si +e+'ri ai se$ei is+aeii-r
"e%en"eni "e hasis, $un-s$ui %enru a$ee -r
"e (i-ena exre+a*
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• Hasisu era .--si in $a"ru $ere+-nii-r$-e$i(e riuai$e a "i(erse %-%uaii
• Se %-ae +an$a# %ra<iuri &/a+ash>ar+-"a/, .asu$h* in arie -rienae in
$-+'inaii $u aune si .isi$
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INTOICATIA CANNABIS
• C-nsu+ re$en• Tu'urari $-+%-ra+enae si %sih--!i$e#
2 u'urari "e $--r"-nare,
2 eu.-rie, anxieae, 2 seni+enu "e in$einire a i+%uui &"e.-r+ea1a
%er$e%ia i+%uui*,
2 u'urarea <u"e$aii, i1-are
• Tu'urarea +e+-riei "e s$ura "uraa
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• Sare "e an"ree $-+uni$ai(a,
sus$e%i'iiae, iariae, "ar si i+%usi(iae&i1'u$niri "e a!resi(iae*
• a1a exai$a# exa1 ineri-r si ne%uina
.i1i$a +ar$aa, a'uie• S-+n .ara %eri-a"e REM 6 a re1ire# - sare
"e %r-asa "is%-1iie, asenie, a+ne1ie
• D-1e +ari# sare $-n.u1i-naa,"e%ers-nai1are, hau$inaii (i1uae inens
$--rae
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Sine1a a si+%-+e-r %sihi$e ae
in-xi$aiei• D-1e +i$i
2 Reaxare
2 Eu.-rie
2 Aerarea %er$e%iei i+%uui si a a-r %er$e%ii
sen1-riae
• D-1e +ari 2
Hi%ersen1ii(iae sau $hiar %aran-ia 2 Anxieae, %ani$a
2 Dereai1are, "e%ers-nai1are
2 Hau$inaii &au"ii(e, (i1uae*
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Si+%-+e ;s-+ai$e=
• C-n<un$i(ia
• Exre+iai re$i
• Us$a$iunea !urii
• Tahi$ar"ie, hi%-ensiune -r-sai$a
• Creserea a%eiuui
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C-nse$ine
• Nu se "es$rie un sin"r-+ "e se(ra<
• Uii1are in"eun!aa#
2 ar-.ie $ere'raa, sin"r-+ "e a%aie
2 s$a"e %ra!u $-n(usi(an,
2 a.e$ea1a .au
2 s$a"e rea$i(iaea i+una
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• De%resia si u'urarie anxi-ase "e ? -ri +ai
.re$(ene a $-nsu+a-rii $r-ni$i "e$a in
%-%uaia !eneraa
• Ris$ $res$u "e a re$e a $-nsu+u un-r
"r-!uri +ai ;n-$i(e=
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Traa+enu "e%en"enei
• C-nsiiere
• Psih-era%ie
• Pr-!ra+e "e %re(enire s-$iaa
• @ se% !r-u%s 6 !ru%uri .ara era%eu
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Psihoterapie
2 in"i(i"uaa
2 "e !ru%
Psihoterapie:
2 Su%-ri(a
2 C-%in!6.-$use" &srae!ii s%e$i.i$e "e a"a%are*
F ex# era%8 $-!nii( $-+%-ra+enaa
2 De1(-area "e a'iiai s-$iae &S-$ia s/is* 2 Iner%ers-naa
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Pr-!ra+e "e %re(enirea re$a"eri-r
&Rea%se %re(eni-n*
• Iner(enie 'a1aa %e e(i"ene siini.i$e
• Isi %r-%une#
2 re"u$erea nu+aruui si se(eriaii re$a"eri-r,
2 $ienii "e(in ;%r-%rii -r era%eui= sau a!eni
ai +eninerii s$hi+'arii in sensu i+%i$arii $a
+ai a$i(e in %r-$esu era%eui$
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• Obiective:
2 I"eni.i$area, ani$i%area si +ana!e+enu
siuaii-r "e +are ris$
2 Mana!e+enu craving 6uui
2 I"eni.i$area si $-re$area er-ri-r "e !an"ire si
a !an"uri-r au-+ae
2 S$hi+'area siuui "e (iaa 2 si "e (iaa +ai
sana-s, -r"-na
2 Pre(enirea rans.-r+arii unei ;s$a%ari= inr6-
re$a"ere
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HALUCINOGENE
• Cee +ai ras%an"ie# 2 LSD &"ieia+i"a a$i"uui iser!i$*
2 DMT &"i+ei ri%a+ina*
2 Naurae# %si-$i'ina &$iu%er$i*, +es$aina&$a$us*
• --sie +ai aes "e ineri
• A$i-nea1a %e sise+u ser--niner!i$• Nu se "es$rie sin"r-+ "e se(ra<
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LSD
• ;A$i"=, ;B--+ers=, ;e-> sunshine=,
;Mi$r-"-s=, ;Su!ai(a=
• -r+e "e %re1enare# a'ee, i$hi" &%i$urare %e 1ahar $u'i$*, rans$uan
• E.e$ 36@ h
• Dr-! a ;eie-r= 2 $-nsu+a-ri $u %re!airesu%eri-ara si)sau siuaie .inan$iara 'una
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INTOICATIE HALUCINOGENE
Tu'urari "e $-+%-ra+en si %sih--!i$e#
2 anxieae)"e%resie
2 i"ei "e re.erina
2 i"eaie %aran-i"a
2 a.e$area <u"e$aii
2 "e%ers-nai1are
2 "ereai1are
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2 Hau$inaii (i1uae !r-esi, in a'asru6(er"e
2 Hau$inaii !e-+eri$e
2 Cu-ri (ii in .ash6uri &$ur$u'eu* 2 Desriu# aer-%sia 2 ;(e"e aeru=
2 Tu'urari "e %er$e%ie e+%-raa
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2 La'iiae e+-i-naa 2 C-+%-ra+en as-$ia i"eii "e
in(unera'iiae F ris$ au-"isru$i(
2 Du%a $-nsu+# s-+n %r-.un" &en see%*
2 Asenie re1i"uaa +ar$aa &a'seneis+ a
ser(i$iu in 1iee "e uni*
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Si+%-+e ;s-+ai$e=
• Mi"ria1a
• Tahi$ar"ie
• Trans%iraii
• Tre+-r
• In$--r"-nare +--rie• Hi%errea$i(iae re.exa
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OPIOIDE
• O%iu+ &.--si "e a%r-x8 7?44 ani in China*
• Se -'ine %rin s$ari.i$area $a%sue-r i+aureae %anei Pa%er S-+ni.eru+ A'u+ &+a$
a'* 2 $-nin 4 a$a-i1i -%i-i1i
• Cee +ai +ari ari %r-"u$a-are# Thaian"a,
Bir+ania, Ne%a, A.!anisan
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Dae e%i"e+i--!i$e
• SUA#
2 $-nsu+a-ri "e her-ina# 344,4446J44,444
2 Pers-ane $are au $-nsu+a &"e6a un!u (ieii*#7 +ii-ane
2 Varsa +e"ie a $e-r $are au iniia re$en
$-nsu+u# 9 ani &"e -'i$ei in$e% a
a"-es$ena, $hiar si "e a @4 aniK*
2 Bar'ai).e+ei# 7)@
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• A$a-i1i naurai# morfina &;>hie su..=*,
$-"eina
• A$a-i1i "e se+isine1a# ei+-r.ina,
heroina &;>hie=, =<un/=, =s+a$/=, =s$a!=,
=!ear=*, hi"r-+-r.-na
• A$a-i1i "e sine1a# +e%eri"ina, %ei"ina,metadona &!-"en san"ar" in raa+enu
"e%en"enei -%i-i"e* e$
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• ana!-nisi# na-x-na, narex-na, na-r.ina
2 %enru raa+enu su%ra"-1ei
• a!-nis6ana!-nis# 'u%ren-r.ina 2 e.i$ien
in raa+enu "e%en"enei
• Re$e%-ri -%i-i1i
• en/e.aine, en"-r.ine
• e.e$ DA, NA
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• T-erana se "e1(-a ra%i"
• C-6+-r'i"iae i+%-rana#
2 "e%resie, u'urare 'i%-ara
2 anxieae
2 "e%en"ena a a$--, "ar si a ae su'sane
2 u'urare "e %ers-naiae anis-$iaa,
2 Pers-nau +e"i$a 2 ex%us "a-ria a$$esuui a
su'sane
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INTOICATIA 6 OPIOIDE
• C-nsu+ re$en• Tu'urari "e $-+%-ra+en si %sihi$e#
2 eu.-rie ur+aa "e a%aie, "is.-rie,
2 a!iaie sau en-are %sih-+--rie, 2 aerarea <u"e$aii
• Sari i+%usi(6a!resi(e
• Tea+a "e ese$, si+a "e sine s$a1ua
• Tu'urari "e aenie si +e+-rie
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Si+%-+e ;s-+ai$e=
• Mi-1a &+i"ria1a in su%ra"-1a*
• Di1arrie
• Se"are
• C-+a
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Ae si+%-+e, $-+%i$aii
• Greaa
• Varsauri
• Neur-%aie %eri.eri$a
• Pruri
• Hi%-+-i-ae !asr-inesinaa• S%as+ %i-ri$, %an$reaia
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• Hi%-ensiune
• S$a"erea $-nraiiaii $-r"uui
• Reenie urinara
•E"e+ %u+-nar
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SUPRADOZA 6 Ur!ena
• De$es %rin s-% res%ira-r • C-+a, "is%nee, hi%-er+ie, hi%-TA, 'ra"i$ar"ie
• C-+a +i-1a "e%resie res%ira-rie Fsu%ra"-1a "e -%i-i1i
• Traa+en# 2 ana!-nis &Na-x-na*
2 su%ra(e!herea .un$ii-r (iae
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SEVRA 6 OPIOIDE
•O%rirea sau re"u$erea $-nsu+uui saua"+inisrarea unui ana!-nis "u%a -
%eri-a"a "e $-nsu+ "e -%i-i"e
• Dis.-rie
• Greaa, (-+a
• Dureri +us$uare
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• La$ri+are, rin-ree
• Trans%iraii
• Mi"ria1a,
• Pi-ere$ie,
• Diaree
• e'ra• Ins-+ie
Sine1a si+%-+e-r se(ra<uui
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Sine1a si+%-+e-r se(ra<uui
Us-r)+-"era
2 An-rexie
2 Anxieae
2 Cra(in!
2 Dis.-rie
2 ai!a'iiae
2 Ce.aee
2 Iria'iiae
2 La$ri+are
2 Mi"ria1a &us-ara*
2 Trans%iraii
2 Pi-ere$ie &;%iee"e !aina=*
2 Neinise
2 Rin-ree 2 Cas$a
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Sine1a si+%-+e-r se(ra<uui
M-"era)se(er
• Cra+%e a'"-+inae
• Ins-+nie
• ris-ane
• Hi%erensiune
• Tahi$ar"ie
• e'ra
• Dureri +us$uare si
ari$uare)-s-ase
• S%as+e +us$uare• Mi"ira1a
• Greaa
• V-+a
O A A
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MODALITATI DE
ADMINISTRARE
• Ora
• Pri1a
• In<e$a'i &;%a--!ie "e serin!a=*# i(, s$ $uris$ "e
2 in.e$ii -$ae &$euie,.as$iie ne$r-1ane* sau
2 sise+i$e &hepatita, HIV, se%i$e+ii*
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ABORDARI TERAPEUTICE
• E"u$aie si s$hi+' "e serin!i
• Su'siuie# Mea"-na# 46J4 +!)1i a%-i
e(enua $-ni"ina
• Meninerea %e +ea"-na 6 a(ana<e
• Ae era%ii "e su'siuie# 'u%ren-r.ina
&a!-nis)ana!-nis*, e(-6a.a6a$ei+ea"-• Tera%ia "e "uraa $u ana!-nisi 6 "is$ua'i
• Srae!ii era%eui$e % !ra(i"ee "e%en"ene
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Pr--$ae "e "e-xi.iere
Substituire cu metadona a%-i re"u$ere re%aa• Zi @
2 Se in$e%e $u @464 +!
2 Da$a %ersisa si+%-+ee "e se(ra< "u%a - -ra se %- a"au!a ?6@4 +! +ea"-na
2 D-1a iniiaa +ax 74 +!
2 D-1a +ax %e 9 -re# 94 +! &in %ri+ee 1ie* 2ex$e%ie $ei $are au un $-nsu+ "-$u+ena
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• Ziua 769# se +enine - "-1a sa'ia
• Ziua ? %ana a in$heierea se(ra<uui# se
s$a"e "-1a re%a $u @46@?: %e 1i
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• A"+inisrarea "e $-ni"ina# se in$e%e $u 4,@6
4, +! a 963 -re %ana a @ +! &in %ri+a 1i*,
a%-i se (a re"u$e re%a
• Ae raa+ene a"<u(ane#
2 Aniin.a+a-are
2 Ben1-"ia1e%ine
2 Anie+ei$e
2 Reaxane +usu$are
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Psih-era%ie si ae iner(enii• Psih-era%ie
2 $-!nii( $-+%-ra+enaa
2 $-%in!6.-$use"
2 %sih-"ina+i$a &+ai %uin*
• Rea'iiare %sih-s-$iaa 6 %re(enireare$a"eri-r
• Insiuii s%e$iai1ae &ae sauui sau ONG6
uri*• Nar$-i$ii an-ni+i 6 !ru%uri "e su%-r &au-6a<u-r*
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Har+ Re"u$i-n si
Traa+enu su'siui(
• Har+ re"u$i-n F re"u$erea
$-nse$ine-r ne!ai(e as-$iae$-nsu+uui "e "r-!uri
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E.e$e %-1ii(e ae ra8 su'siui(
&+ea"-na*
• $-nsu+u "e -%ia$ee ii$ie &her-ina*
• nr8 "e "e$ese %rin su%ra"-1a
• .re$(ena in<e$arii
• rans+ierea in.e$iei HIV)he%aia
• raa a$i(iai-r ie!ae si a $-n"a+nari-r
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• $aiaea (ieii
• ni(eu "e sanaae
• $a%a$iaea "e !asi si %asra - su<'a
• .un$i-narea s-$iaa
• .un$i-narea .i1i$a
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C-nse$ine ne!ai(e as-$iae
$-nsu+uui "e "r-!uri
• La a"resa in"i(i"uui#
2 S-$iae si %ers-nae# "i.i$uai in +eninerea si
!asirea unei su<'e, "i.i$uai .inan$iare,i1-are s-$iaa
2 Le!ae
2 De sanaae# "ire$ %rin a$iunea "r-!uui, %r-'e+e e!ae "e in<e$are &HIV,He%aie*, si
nesana-s "e (iaa
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• La a"resa $-+uniaii#
2 Ras%an"irea '-i-r $u rans+iere %areneraa&HIV, He%aia B,C* si a a-r '-i
2 Cri+inaiae
2 Vi-ena
2 -r+area "e !he-uri ae $-nsu+a-ri-r
2 Creserea $heuiei-r %u'i$e
2 Er-"area seni+enuui "e si!urana %u'i$a
2 Si!+ai1area, i1-area si $ri+inai1area
$-nsu+a-ri-r