Drug and substance abuse a case of prescription drugs
When medication is prescribed to be used for cases that are non-medical, the abuse of such drugs is called prescription drug abuse. Just like any other drug for abuse, prescription drugs abuse can result in dependence, addiction, and once the victim has stopped using them for a while, they experience “Withdrawal symptoms: Tachycardia, hypertension, hyperthermia, diaphoresis, hand tremors, insomnia, nausea, and psychomotor agitation”, as indicated by Schub, Glendale, and Walsh (3). Prescription drugs like opioids and central nervous system depressants are used alongside other drugs of abuse and alcohol. For instance, opioids like Hydrocodone are prescribed to relieve pain problems, but can be used to induce a temporary state of euphoria. The topic is linked to me since I have been once a Vitim for the use of oxycodone just to have a short while of induced euphoria to manage my stress episodes. “Drug abuse is a chronic public health problem, affecting all levels of society, with potentially irreversible consequences.” as shown by Rhea and Reynaldo (396). For this reason, it requires various stakeholders that included the public in helping with the problem. “Prescription drug abuse/misuse is increasing. Nonmedical use of prescription medications, especially opioid analgesics, now is considered an epidemic in the United States. Medical-surgical nurses are in a strategic position to help address substance abuse problems in patients” as shown by Rhea and Reynaldo (396).
Signs and symptoms
Since the most abused prescription drugs are various types of opioids and those that depress the central nervous system, this part of this writing will elaborate on signs to warn about during an encounter with a victim of prescription drugs. Opioids victims present with symptoms that include “psychomotor agitation or retardation, pupil constriction, reduced the respiratory rate, drowsiness, and slurred speech” as indicated in Schub, Glendale, and Walsh (2). Once the user of opioids has become addicts and the signs and symptoms have become too eminent, and their life have been disrupted negatively by the abuse, they tend to withdrawal from the usage. The victims end up in “Withdrawal symptoms: Nausea, muscle aches, lacrimation, rhinorrhea, pupil dilation, diaphoresis, diarrhea, fever, insomnia, goose bumps, restlessness, and pain” Glendale, and Walsh (2).
The central nervous system can be affected by either depressing its functioning or stimulating. Prescription drugs can be used for non-medical purposes to achieve the two function based on the user’s interests. Some signs and symptoms for CNS depressants use include, “Slurred speech, incoordination, unsteady gait, drowsiness, confusion, nystagmus, and stupor” as indicated in Schub, Glendale, and Walsh (3). Addicted users have developed dependence on the CNS depressants, and once they want to change to avoid worsening of the conditions, they enter into a phase of withdrawal. The following signs are used to identify cases where depressants for the central nervous system for non-medical purposes have been used. Insomnia, nausea, hyperthermia, hypertension, and hypertension and insomnia.
The second type of the non-medical drugs affecting the Central Nervous system is the stimulant. The sign and symptoms after the use of the stimulants include a reduced appetite, insomnia where the victim cannot have sleep as other persons since they are overly alert. Hypertension, hypothermia, and tachycardia. Once they CNS have been stimulated by these drugs and one experiences those signs for a long period they become a dependent and the craving for continual use is established. They following are withdrawal symptoms. The victims become “Fatigued, depression, delirium, irritability, and violent behavior” as indicated by Cabrera, Glendale, and Uribe (3). The three drugs used are just a sample since most of the non-medically used prescription drugs exhibit almost similar signs and symptoms. The same presentation is used during a clinical examination to determine the kind of drug abused and what extent so that a treatment regimen can be established to help deal with the situation.
The incidence of prescription drugs users in the USA
Many labs are turning to a “dilute and shoot” LC/MS/MS approach when analyzing urine samples because this technique ensures that drug compounds are not lost during the preparation procedure. But it can also cause many negative downstream effects, which can lead to increased cost per sample due to maintenance and downtime. The cause of these issues can often be attributed to the hydrolysis procedure, which is required when performing urine analysis. In a sample urine matrix, drugs are often present as a glucuronide metabolite. It is standard practice to remove the glucuronide moiety before LC/MS/MS analysis using a hydrolysis procedure to ensure that the drugs are accurately confirmed and quantified ed. Hydrolysis can be performed in several ways; enzymatic hydrolysis using ß-glucuronidase is often preferred because it does not require the use of harsh acids and is a rather simple procedure. While simple, however, the procedure does introduce a new component to the sample: an enzyme. Enzymes are protein molecules that, when injected onto an HPLC column or into a mass spectrometer, can reduce sensitivity, clog columns, and build upon the mass spec source. This will eventually lead to required maintenance and subsequent downtime. There are several methods to remove the enzyme before analysis, but most of these methods include more targeted sample preparation procedures that require method development such as solid phase extraction (SPE). So, despite its limitations, many labs still prefer simple sample preparation methods such as “dilute and shoot.” An optional centrifugation procedure can be performed to remove the ß-glucuronidase enzyme, but removal is often not complete. Incomplete removal of the enzyme will eventually increase backpressure (Figure 1), reduce sensitivity, and cause problems with the mass spec instrument. ß-glucuronidase: an “out of the box” approach Historically, protein precipitation has been favored as a go-to preparation technique for samples that are protein-rich, such as plasma. Urine does not typically contain significant amounts of protein and would not usually benefit t from a protein precipitation procedure. However, urine that has been subjected to enzymatic hydrolysis with ß-glucuronidase contains a significant amount of enzyme, which by definition is a protein. Recently, screening labs have been applying a protein precipitation technique to remove the enzyme and ensure minimum wear and tear on the column and instrument. The technique is both rapid and simple, requiring about five minutes plus dry-down time and virtually no method development. Protein precipitation is also effective, resulting in >33x increase in HPLC column lifetime and a significant reduction in backpressure (Figure 2) and mass spec downtime for maintenance. Because the technique is non-selective, it removes only
“It is estimated that the United States consumes approximately 75 percent of the world’s prescription drugs, and a staggering 52 million people over the age of 12 have used prescription drugs for nonmedical purposes in their lifetime.” as shown in (Pike 42). The population of persons using prescription drugs for a non-medical purpose have increased similarly to the users of illicit drugs. It has been reported that individuals who abuse prescription drugs are at a higher risk and have high chances of trying one type or another illegal drug. “For example, recent data indicate that there is a link between prescription opiate addiction and heroin abuse because the two substances target the same receptors. Those using opioids once they discover barbiturates can have same and even better feeling they get from a given prescription drug, they are tempted to use it. Before they know it, they are already addicted and are no longer using prescription drugs but already practicing the use of other illicit drugs. The laboratories are finding it hard to develop new forms of opioids to meet market demands for some persons out of over suing are already resistant to these drugs intended effects and that’s the reason for trying alternative illicit drugs. This has posed a challenge to the lab technicians and poses a challenge in ensuring there are enough prescription drugs in the market in high and expected quality.
In 2012, the abuse of prescription drugs with a particular of opioids accounted for about 6.8 million persons 12 years and over using it. The use was ranked second with “abused prescription drugs in 2012, up slightly from 2011 and second only to marijuana” as shown in (Schub and Glendale, Walsh 2), where marijuana is illicit, and opioids are prescription drugs that are used for non-medical functions. “Youths and children between age 18- 25 years and age 12- 17 years accounts for 53% of the abuse of prescriptions drugs in America” according to the report by National Survey on drug use and health published in 2012 as indicated by Schub and Glendale, Walsh. The reason for such high incidence and prevalence of abuse of prescription drugs is due to the convenience of access and are also comparatively cheaper to illicit drugs, which may lead to a similar feeling in the body. According to Schub et al., in South Florida, it is easy to access the prescription drug that can be used as the heroine than heroine.
Diagnosis and Treatment
Urine screening to detect some toxins can be used to determine the amount of drugs that a victim of abuse of prescription drugs has to be taken before an intervention is made. Also, X-ray images of the chest can help pulmonary infection and effusion since some drugs are so irritating and may lead to a development of lesions. On physical assessment some patient due to a long period associated with lack of appetite due to the use of depressants of the CNS, appear malnourished. The patients may also appear unkempt apart from having scars as a result of injectable prescription drugs. The electrolysis of serum can help reveal abnormalities in the victim’s body as indicated in Schub et al. Prescription drug user has cases of damaged liver due to the overworking it. The patients should be subjected to the liver functioning test to ascertain whether it is properly working or has it been potentially damaged. HIV test can be conducted for those who have shared an injection to enhance the treatment.
Treatment can start by offering an emergency care to those who have overdose cases. The emergency care may include an entire bowel irrigation or an induced emesis. The maintenance of respirations as directed is important in the care. Naloxone is administered as ordered or also flumazenil is administered in cases of intoxication by benzodiazepine. Later the symptoms are managed by monitoring that the patient’s vital signs like cardiac output and input, neurological status, weight, mental condition, respiration, and sleep patterns are according to the expectation for a person of the particular gender and age. For instance out of “withdrawal symptoms from the use of depressant opioids, the victim may show some mental illness like being in a state of a stupor” as indicated in (Rhea and Reynaldo 398). The patient safety should be ensured with measure available for management of seizures cases. For withdrawal cases, the victim is educated on the symptoms and given strategies to relief the effects. The patient is given specific drugs to deal with specific sign, for instance, antidepressants are given to deal with depression cases. Naltrexone and buprenorphine are administered to deal with opioids addiction and withdrawal symptoms respectively. The patient history on reaction to specific drugs should be established either by conducting tests or talking to the patients to ensure they don’t get an adverse reaction while using some drugs of treatment. Emotional support is required in the management of the cases. Due to emotional imbalances, the victims are at higher risks of developing ideas of suicide and should be helped to think positively. Victims may have the personal problem and should be contributed to addressing the problem. For instance, in a research study conducted in Massachusetts “for the reason of tobacco use, it was noted that the homeless out of frustration were at higher risk of starting the abuse of tobacco” as shown in (Baggett et al. 1193).
In conclusion, the abuse of prescription drugs is on the rise and the solution is by the use of multi-stake holders approach to ensure there is an integrated support of the youths and other persons including children below legal age. The abuse of prescription drugs is on the rise, and since it’s not illegal once a person has obtained those drugs in whichever means new drug user are being modeled which is affecting the society. Hence contributing to the rise in more illicit drug users. Opioids are among the most abused prescription drugs with the person between 12 and 25 being the highest user in America.
Baggett T., Chang Y., Singer D., Porneala B., Gaeta J., O’Connell ., and Rigotti N. “Tobacco-, Alcohol-, and Drug-Attributable Deaths and Their Contribution to Mortality Disparities in a Cohort of Homeless Adults in Boston.” American Journal of Public Health. 105.6 (2015) 1189-1196.
Cabrera G., Glendale, and Uribe L. “Substance Abuse: Prescription Drugs (OxyCONTIN)” Published by Cinahl Information Systems. 8 May 2015. Print
Pike E. “New approaches to screening for drug abuse: The increasing link between abuse of prescription and illicit drug abuse is creating new challenges for labs.” Future buss. October. 2015: 40-48
Rhea F. and Reynaldo F. “Recognizing Signs of Prescription Drug Abuse and Addiction, Part I” CNE Nursing Pharmacology SERIE. 23.6 (2014).391-396.
Schub E. and Glendale, Walsh K. “Substance Abuse: Prescription Drugs.” Published by Cinahl Information Systems. 24 April, 2015. Print
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