Dr Okonoda, Kingsley Mayowa

Medical Director/Psychiatrist in Chief,

Netwealth Centre for Addiction

Management, Jos

Vice Chairman, Nigerian Medical

Association,

Plateau State.

Introduction

• June 26 is the International Day against Drug Abuse and Illicit Trafficking. Established by the United Nations General Assembly in 1987, this day serves as a reminder of the goals agreed to by Member States of creating an international society free of drug abuse.

• The United Nations Office on Drugs and Crime (UNODC) selects themes for the International Day and launches campaigns to raise awareness about the global drug problem.

• Health is the ongoing theme of the world drug campaign.

• We invite everyone to mark 26 June! • It is a unique occasion to take a stand

against a problem that affects us all. • We count on your support to make this

pro-health campaign a success.

Themes: From 2000 till now.

• 2010 -2014: Health was an ongoing the theme of the world drug campaign.

• 2007-2009 - "Do drugs control your life? Your life. Your community. No place for drugs."

• 2006 - "Value yourself...make healthy choices"• 2005- "Drugs is not child's play"• 2004 - "Drugs: treatment works"• 2003 - "Let's talk about drugs"• 2002 - "Substance abuse and HIV/AIDS"• 2001 - "Sports against drugs"• 2000 - "Facing reality: denial, corruption and violence

Theme: 2015

What are drugs?

• Technically speaking, they are chemical sub- stances that affect the normal functioning of the body and/or brain.

• Drugs are chemicals that alter, block, or mimic chemical reactions in the brain. This causes an alteration of the body's normal processes, causing physical (Faster heartbeat, deeper respiration etc.), or mental (Elevated mood, new thought processes etc.) changes.

-Urban online Dictionary

What is Drug Abuse?

• Drug (substance) abuse is the use of any drug (substance) for an unintended purpose or in an excessive amount.

• All drugs (substances), whether legal or illegal, have an impact on health when used in the wrong way. Different sub-stances have different effects on the body.

Types of Drugs

1. Legal (Licit) Drugs: • For example, caffeine (found in coffee or Coca-

Cola), nicotine (in cigarettes) and alcohol are all technically legal drugs, although they are usually not referred to as such.

• Medicines, whether prescribed by a doctor or available over the counter at pharmacies, are legal drugs to help us recover from illnesses, although they can also be abused.

2. Illegal (Illicit) Drugs: • Illegal drugs are drugs that are so harmful that

countries across the world have decided to control them.

• Countries have passed several international laws, in the form of United Nations conventions, that specify which drugs are controlled.

• All drugs (especially illegal) have immediate physical effects. But drugs can also severely hinder psychological and emotional development, particularly among young people.

• In fact, drugs can take away potential that users can never get back as drugs substitute the development of other, natural coping mechanisms.

• Drugs cloud the judgement of users. • This means that drug users often take more

risks, such as having unsafe sex. • This can lead to them getting infected with

hepatitis or HIV and other sexually transmitted diseases

Common Drugs of Abuse

• Virtually any substance whose ingestion can result in a euphoric ("high") feeling can be abused.

• Research reports from Nigeria show the following psycho-active substances as those commonly abused in West Africa, particularly Nigeria:

• (a) alcohol; • (b) cannabis; • (c) hypno-sedatives (e.g., Valium, Ativan, sleeping

pills);• (d) CNS stimulants (e.g., amphetamine-type

stimulants, ATS); • (e) opiates (e.g., heroin, morphine, codeine); • (f) solvents (e.g., glue, cleaning fluids, gaso-line); • (g) mild CNS stimulants (e.g., kolanuts, caf-feine,

prophis, nicotine); • (h) synthetic substances (e.g., methaqualone); • (i) hallucinogens (e.g., LSD).

Cannabis

• Cannabis is a tobacco-like greenish or brownish material made of the dried flowering tops and leaves of the cannabis (hemp) plant.

• All forms of cannabis are usually smoked. Cannabis resin and oil can also be swallowed or brewed in tea.

• Cannabis can make users feel pleasurably relaxed and some- times euphoric. Users may also experience a more vivid sense of sight, smell, taste and hearing.

Health Risks of Cannabis• In the short term, users have an increased

appetite and pulse rate. • Users also have problems performing physical

and intellectual tasks such as driving a car and thinking logically.

• With large doses, users´ perceptions of sound and colour may be sharpened, while their thinking becomes slow and confused.

• If the dose is very large, the effects of cannabis are similar to those of hallucinogens and may cause anxiety, panic and even psychotic episodes.

Health Risks of Cannabis

• Regular users of cannabis risk developing psychological dependence to the point where they lose interest in all other activities, such as work and personal relationships.

• Recent studies in the United Kingdom show a link between cannabis use and an increase in schizophrenia.

• Cannabis smoke contains 50 per cent more tar than high-tar cigarettes, which puts users at an increased risk of lung can- cer and other respiratory diseases.

5

My brother used to be kind, funny, intelligent, thoughtful and caring, now I don't know him any- more; this is through drugs.

I want young drug users to understand that you don’t only ruin your own lives with drugs, but that of everyone you are supposed to love around you. Have you ever considered this? Or do these drugs fill you with such selfishness that all you can think about is yourself?

My brother is not a hard drug user to my knowledge but has a heavy addiction to cannabis. Well, ifyou think this is one of the lighter drugs you are truly deluded.

Cannabis in my brother’s case has changed his per- sonality so much so that I feel I do not know the person living in the next bedroom. He has no ambi- tion, no respect and no care for personal hygiene.

The only people he seems to care about are his friends who are also addicted to drugs.

My mum is extremely kind and loving, and he frequently abuses this by taking herfor granted at every opportunity and making her feel worthless. When he’s out every night with his friends she con- stantly worries about him. He has no job and no money and I suspect he and his friends steal from our house.

If he knew or cared what he has put my mum through, I doubt he would feel that taking drugs and behaving the way he does would be worth it.

I am 21 and have never taken any drugs; do I feel like I am missing out? I don’t think so!Anonymous story submitted to talktofrank.com. Reprinted with permission.

c a n n a b i s c h a n g e d m y b rother

Heroin

• Heroin is an addictive drug with pain-killing properties pro- cessed from morphine, a naturally occurring substance from the opium poppy plant.

• Pure heroin is a white powder. Street heroin is usually brownish white because it is diluted or “cut” with impurities, meaning each dose is different.

• It is usually injected but can also be snorted, smoked or inhaled.

• how does it affect users?• Heroin can relieve users´ tension, anxiety and

depression. • Users feel detached from emotional or

physical distress or pain. • With large doses, users may experience

euphoria

Health Risks of Heroin

•Short-term effects include constricted pupils, nausea, vomit- ing, drowsiness, inability to concentrate and apathy.•Heroin is very addictive and users may quickly develop physical and psychological dependence. They also risk developing tolerance for the drug, which means they need constantly higher doses to achieve the effect they want.

•Long-term heroin use has a variety of severe health effects. •Among other things, it can cause severe weight loss, malnutrition and constipation. •It can also lead to menstrual irregularity, sedation and chronic apathy.•Abruptly quitting heroin use leads to withdrawal symptoms which can be severe such as cramps, diarrhoea, tremors, panic, runny nose, chills and sweats.

•Other risks•Users risk overdosing on heroin, which can lead to coma and death through respiratory depression.

Other drugs like heroin!

• Codein.• Pentazocine• Pethidine.• Tramadal.

Smack/H/Horse/Junk/Harry/White ladySmack/H/Horse/Junk/Harry/White lady

Cocaine

• Cocaine is a fine white or off-white powder that acts as a powerful stimulant.

• It is extracted from the leaves of the coca plant. • On the street, it can be diluted or “cut” with other

sub- stances to increase the quantity. • Crack is cocaine that has been further processed

with ammonia or sodium bicarbonate (baking soda) and looks like small flakes or rocks.

Effects

• Cocaine is usually sniffed/snorted or injected, whereas crack is smoked.

• Cocaine can make users feel exhilarated and euphoric.

• Furthermore, users often experience a temporary increase in alertness and energy levels and delayed hunger and fatigue

Health Risks of Cocaine

•Short-term effects include loss of appetite, faster breathing and increased body temperature and heart rate. Users may behave bizarrely, erratically and sometimes violently.•Excessive doses of cocaine may lead to convulsions, seizures, stroke, cerebral haemorrhage or heart failure.

Health Risks of Cocaine

•Long-term users of cocaine risk a number of health problems, some of them depending on how they take the drug. •Sniffing cocaine severely damages nose tissue; smoking can cause respi- ratory problems; whilst injection can lead to abscesses and infec- tious diseases.

Health Risks of Cocaine

•Other risks, regardless of how the drug is taken, include strong psychological dependence, malnutrition, weight loss, disorientation, apathy and a state similar to paranoid psychosis.•Mixing cocaine with alcohol is a dangerous cocktail and can greatly increase the chances of sudden death.

Methamphetamine

•Methamphetamine is part of the group of drugs called amphetamine-type stimulants (ATS). It is a synthetic drug that is usually manufactured in illegal laboratories.•Methamphetamine comes as a powder, tablet or as crystals that look like shards of glass.•The NDLEA has recently discovered and destroyed two factories of amphetamine in Nigeria!

Use and Effects

• It can be swallowed, sniffed/snorted, smoked or injected.

• Methamphetamine stimulates a feeling of physical and mental well being, as well as a surge of euphoria and exhilaration.

• Users experience a temporary rise in energy, often perceived to improve their performance at manual or intellectual tasks.

• Users also experience delayed hunger and fatigue.

Health Risks

•Short-term, users can lose their appetite and start breathing faster. •Their heart rate and blood pressure may increase and their body temperature may rise and cause sweating. •With large doses, users can feel restless and irritable and can expe- rience panic attacks.

•Excessive doses of methamphetamine can lead to convulsions, seizures and death from respiratory failure, stroke or heart failure.•Long-term methamphetamine use can lead to mal- nutrition, weight loss and the development of psychological dependence.•Once chronic users stop taking methamphetamine, a long period of sleep, and then depression, usually follows.

Risk of Psychosis.

• Methamphetamine use sometimes triggers aggressive, violent and bizarre behaviour among users.

Ecstasy

•Ecstasy is a psychoactive stimulant, usually made in illegal laboratories. •In fact, the term “ecstasy” has evolved and no longer refers to a single substance but a range of substances similar in effect on users. •Frequently, any tablet with a logo is now referred to as “ecstasy” regardless of its chemical makeup.•While the drug is usually distributed as a tablet, it can also be a powder or capsule. Tablets can have many different shapes and sizes.

Effects

• It is usually swallowed but can also be snorted or injected.

• Ecstasy can heighten users´ empathy levels and induce a feel- ing of closeness to people around them. It can also make users feel more sociable and energetic.

Health Risks of Ectasy

•In the short term, ecstasy can make the body ignore distress signals such as dehydration, dizziness and exhaustion and it can interfere with the body’s ability to regulate temperature. •Furthermore, ecstasy can severely damage organs such as the liver and the kidneys. Use can lead to convulsions and heart failure.

Health Risks of Ecstasy

•Large doses of ecstasy also cause restlessness, anxiety and severe hallucinations.•Long-term ecstasy use can damage certain parts of the brain, resulting in serious depression and memory loss.•Tablets or pills that are sold as “ecstasy” may contain other potentially dangerous substances which can vary widely in strength and effects

Other Prescription Drugs of Abuse.

• Barbiturates• These are sedatives like phenobarbital,

pentobarbital (Nembutal), and secobarbital (Seconal).

• They help with anxiety, sleep problems, and some seizures.

• But if you take more than prescribed, you can get addicted.

• High doses can cause trouble breathing, especially if you use them when you drink alcohol.

Other Prescription Drugs of Abuse

• Benzodiazepines• Valium (diazepam) and Xanax (alprazolam) are

two examples of benzodiazepines -- another type of sedative that can help with anxiety, panic attacks, and sleep problems.

• They work well and they're safer than barbiturates.

• But overused, they can also lead to physical dependence and addiction.

Rohypnol

• Rohypnol is the brand name for a drug called Flunitrazepam, which is a powerful sedative that depresses the central nervous system.

• Rohypnol is swallowed as a pill, dissolved in a drink, or snorted.

• Roofies are frequently used in combination with alcohol and other drugs.

• They are sometimes taken to enhance a heroin high, or to mellow or ease the experience of coming down from a cocaine or crack high.

• Used with alcohol, roofies produce disinhibition and amnesia.

Health Risks of Rohypnol

• What are its short-term effects?• The drug creates a sleepy, relaxed, and drunk

feeling that lasts 2 to 8 hours. Other effects may include blackouts, with a compete loss of memory, dizziness, respiratory depression and disorientation, nausea, difficulty with motor movements and speaking.

• What are its long-term effects?• Rohypnol can produce physical and psychological

dependence.

Addiction is a Brain Disorder.

Amygdala – assignment of emotional significance and learned associationOrbitofrontal Cortex (OFT) – encodes outcome expectanciesBasolateral Amygdala (BLA) – facilitates associative learningAnterior Cingulate Cortex (ACC) – discriminative learning and controlHippocampus – Contextual memoryHypothalamic and Septal nuclei – Basic drivesNucleus Accumbens (NAcc) – responses to pleasureVentral Tegmental Area (VTA) – facilitates learning and releases dopaminePreFontal Cortex (PFC) – OFT and ACCDorsal Medial Thalamus – inhibits dopamine

The neural circuitry of behaviour - summary

What is the evidence? (1)

This is imaging that compares problem Gamblers (B) with Controls (A):. There is limited activation of the ventral striatum (reward response) in the addicted brain. The controls display much higher levels of activity – the differences are due to sensitisation

Tolerance - Phenomena where the effects of a drug diminish with

repeated use

• Develops at different rates to different drug effects• Once developed, it does NOT last indefinitely• Cross-tolerance between members of same class of drug

After a prolonged period of abstinence, a user will require a much small dose to gain the same effect. This is particularly problematic in the case of heroin users released from long term prison sentences – most overdose deaths occur in the week following release

What is the evidence? (2)

Agonists and Antagonists

Agonists – such as Methadone – binds to the same receptor as the heroin, but does not produce the euphoria / high. Taken orally, it does not rapidly increase opioid-receptor activity, but does maintain enough activity to avoid withdrawal.

Naltrexone is an opioid antagonist. It prevents heroin from binding to the receptor, but does not activate the receptor. Naloxone (Narcan) also works in this way, and can be used to address overdose by replacing the heroin.

Fighting fire with fire – Pharmaceutical solutions to pharmaceutical problems

What is the evidence? (3)

Medication Treatment for addiction to MechanismMethadone Heroin Opioid-receptor agonistNaltrexone Heroin Opioid-receptor

antagonist

Naloxone Heroin, alcohol Opioid-receptor antagonist

Buprenorphine Heroin Mixed opioid-receptor agonistand antagonist

Nicotine gum, patches Nicotine Provide low doses of nicotine

Has work on the biological basis for addiction contributed towards the development of effective interventions? The utilisation of antagonists to reduce cravings and reverse overdose are good examples of this.

What is the evidence? (4)

What are the risk factors for addiction?

• Permissive family attitudes to substance use

• Use of substances by parents, family members

• Family conflict

• Early and persistent behaviour problems

• Academic problems

• Low commitment to school

• Early peer rejection - alienation

• Association with peers who use drugs

• Attitudes favourable to drug use

• Early onset of alcohol/drug use

Seek Treatment and Help

Netwealth Centre for Addiction Management

• Netwealth Centre for Addiction Management is a treatment and rehabilitation centre for people with alcohol and drug dependence.

• Service Types: 1.Outpatient Treatment 2. Residential Treatment 3. Aftercare.

Our Services

• 1. Screening Services• 2.Comprehensive Assessment• 3.Detoxification• 4.Non-residential Structured Programme• 5.Residential Therapeutic Programme• 6.Structured Family Therapy Programmes• 7.Pharmacotherapy• 8.Aftercare/follow up

Unique Selling Points

• Our 10-bedded facility mimics the home environment, not like a conventional hospital setting.

• There is provision of entrepreneurial training beyond the medical, psychiatric and psychosocial treatment.

Unique Selling Points

• We have a strong programme content that is based on evidenced-based studies on what works.

• A full complement of health professionals in the addiction industry.

Contact Us

• Our Address: Netwealth Consult Ltd,Opposite Mining Quarters,State Low Cost, Rantya,Jos Plateau State• Phone No: 08036770092, 07050245234• Email: netwealth.consult@yahoo.com

IDPC Theme 2015

Support, Don’t Punish.