101: Drug Abuse Flashcards
What is the definition of drug abuse?
Drug abuse is the recurrent use of illegal drugs or the misuse of nonprescription or prescription drugs that results in negative consequences.
What are the most commonly used illicit drugs according to the 2015 UNODC report?
- Cannabis - most widely used drug in the world (excluding caffeine)
- Amphetamines - second most commonly used drugs
- Cocaine
- Prescription opioids - highest negative health impact
What are some environmental risk factors associated with drug abuse?
- Easy access to the drug
- Poor school bonding
- Peer use
- Trauma, both physical and psychological
- Parental use
- Family conflict in the home
What are the protective factors that can reduce the risk of drug abuse?
- Religiosity
- Strong family support
- Social involvement in community organizations
What is the gold standard for diagnosing drug use?
Drug testing is the gold standard for diagnosing most legal and illegal agents, using bodily fluids such as blood, urine, saliva, and hair.
What are the clinical features associated with intravenous drug use?
Track marks are a result of venous thrombosis with subsequent scarring and pigmentation of the veins, caused by:
- Repeated injections
- Use of blunt needles
- Irritation from chemicals added to the injected material
Early lesions may show crusting and ecchymosis, while chronic use can lead to linear cords.
What is the global prevalence of illicit drug use according to the 2015 UNODC report?
5.2%.
Which drug is identified as the most widely used drug in the world?
Cannabis.
What is the significance of recognizing signs and symptoms associated with drug use?
It is crucial and potentially lifesaving.
What historical uses of drugs are mentioned?
Drugs have been used in religious ceremonies, for healing, and for recreation since ancient times.
What is the impact of prescription pain relievers in drug abuse?
They are the second most commonly used drugs and can lead to significant health impacts.
What are the common cutaneous findings associated with drug abuse?
Common findings include dental caries, madarosis, scarring, tattooing, and staining in the skin.
What are the signs of intravenous drug use?
Signs include track marks, which result from venous thrombosis, scarring, and pigmentation of the veins.
What are the associated risk factors for drug abuse?
Associated risk factors include trauma (both physical and psychological), parental use, and family conflict in the home.
What is the significance of twin studies in understanding drug addiction?
Twin studies suggest that at least some component of drug abuse and dependence is driven by genetic preponderance.
What are the clinical features of drug abuse related to skin conditions?
Clinical features include crusting and ecchymosis along the course of a vein due to intravenous drug use.
What are the common sites for intravenous drug use (IDU) and how does scarring relate to drug use duration?
Common sites for IDU include:
- Medial vein in the antecubital fossa of the nondominant arm
- Less visible sites: popliteal fossa, dorsal veins of the feet, inguinal veins
Scarring is associated with longer duration of drug use, and cocaine does not typically induce track marks as it lacks the sclerosing chemicals found in other drugs like heroin.
What are the potential complications of skin popping in drug users?
Skin popping can lead to:
- Irreversible tissue injury resulting in irregular, leukodermic, atrophic scars
- Hypertrophic scars or keloids
- Increased risk of infections, particularly skin and soft tissue infections (SSTIs) due to deeper and multilobulated infections compared to IV injections.
What are the common pathogens associated with skin and soft tissue infections (SSTIs) in intravenous drug users (IDUs)?
Common pathogens cultured in SSTIs among IDUs include:
| Pathogen | Frequency |
|———-|———-|
| Staphylococcus species (particularly Staphylococcus aureus) | Most frequent |
| Group A β-hemolytic Streptococcus | Common |
| Eikenella corrodens | Common in IDUs who clean needles with saliva |
| Clostridium species (e.g., Clostridium botulinum) | Associated with skin popping |
| Gram-negative bacteria and anaerobes | Common in anaerobic infections |
What are the symptoms and treatment options for wound botulism in IDUs?
Symptoms of wound botulism include:
- Blurred vision
- Diplopia
- Ptosis
- Pain, swelling, and tenderness
Treatment options include:
1. Antitoxin
2. High-dose penicillin
3. Surgical debridement
What is necrotizing fasciitis and how is it commonly presented in IDUs?
Necrotizing fasciitis is a severe infection that can occur in IDUs, commonly presenting with:
- Severe pain disproportionate to examination findings
- Abnormal temperature (88% of cases)
- Classic findings include hemorrhagic bullae, systemic toxicity, and palpable crepitans.
Surgical exploration is often necessary in cases with unexplained severe pain.
What are the cutaneous signs of endocarditis associated with intravenous drug use (IDU)?
Cutaneous signs of endocarditis in IDUs include:
- Janeway lesions
- Osler nodes
These signs indicate a link between endocarditis and IDU, highlighting the importance of monitoring for such complications in drug users.
What is skin popping in the context of drug use?
Injecting drugs intradermally or subcutaneously, often when veins can no longer be found.
What are the potential consequences of skin popping?
Irreversible tissue injury leading to irregular, leukodermic, atrophic scars.
What is a common complication associated with skin and soft tissue infections (SSTIs) in IDUs?
Sepsis.
What are some common pathogens cultured from SSTIs in IDUs?
Staphylococcus species, group A β-hemolytic Streptococcus, and oral pathogens like Eikenella corrodens.
What is wound botulism and how is it commonly caused in IDUs?
Wound botulism is most commonly caused by the injection of black tar heroin, which is cut with dirt.
What are the classic findings of necrotizing fasciitis in IDUs?
Hemorrhagic bullae, systemic toxicity, and palpable crepitans.
What is the significance of hyperpigmentation in drug users?
It can be a result of cooking drugs and flaming needles, leading to carbon and soot deposits in the dermis.
What are Janeway lesions and Osler nodes?
Cutaneous signs associated with endocarditis, which has been linked to intravenous drug use.
What are some independent risk factors for SSTIs in IDUs?
Skin popping, use of nonsterile needles, and the use of speedballs (mixture of heroin and cocaine).
What are the common clinical consequences of inhalant abuse?
Inhalant abuse can lead to a wide range of clinical consequences including:
- Mucous membrane irritation: rhinorrhea, epistaxis, sneezing, coughing, excess salivation, conjunctival injection, dyspnea, and wheezing.
- Dermatologic eruptions in the perioral and/or perinasal distribution.
- ‘Huffer’s rash’: perioral or perinasal dermatitis with pyoderma.
- Frostbite on the face or oral/nasal cavity from inhalation of refrigerants or coolants.
- Yellow crust appearance in hand/face dermatitis caused by nitrites.
What are the effects and risks associated with cocaine use?
Cocaine is a sympathomimetic drug that creates feelings of euphoria and can cause:
- Tachycardia, altered mental status, hypertension, and mydriasis.
- Cutaneous signs include halitosis, frequent lip smacking, cuts and burns on the lips, and midline destructive lesions of the nasal septum from snorting.
- Various types of vasculitis, including urticarial vasculitis and Churg-Strauss vasculitis.
What is Levamisole and what are its effects when added to cocaine?
Levamisole is a common adulterant added to cocaine that:
- Increases bulk and weight, enhancing the euphoric effects of cocaine.
- Can cause Levamisole-induced necrosis syndrome (LINES), characterized by distinctive retiform purpura and associated with leukopenia and high titers of specific antibodies.
What are the common methods of heroin administration and their associated risks?
Heroin can be administered through various methods:
1. Injection: Heated and drawn into a syringe, can be done up to 4 times a day.
2. Snorting: Inhaled through the nose.
3. Smoking: Inhaled as vapors, often with tobacco.
Associated risks include:
- Respiratory depression and addiction.
- Cutaneous signs such as urticaria and intense itching (high pruritus).
What is the primary substance from which heroin is synthesized?
Heroin is synthesized from morphine, which is extracted from the opium poppy plant.
What is the primary population that commonly abuses inhalants?
Adolescents are the most common population to abuse inhalants.
