Drugs, Classifications and Harms

Question 1

Define a drug

Answer 1

A chemical which when taken produces physiological changes

Question 2

List the categories of illegal drugs

Answer 2

Depressants (alcohol, opioids, benzos/barbituates, GBB/GBL/butanediol, ketamine)

Stimulants (cocaine, crack, amphetamine, methamphetamine, MDMA/BZP)

Psychadelics (LSD/psylocybin, salvinorum

Cannabis

Question 3

Overview of Drug Regulation in UK

Answer 3

Misuse of Drugs Act (1971) [recreational drugs]
Class A-C
Schedules: (2-3-4 = medicines; 1 = not med recognised; 1 = never medical]

Question 4

Overview of methods that drugs can cause harm

Answer 4

• harms from drug
• harms from route of use
• harms from addiction

Question 5

How can a drug directly cause harm?

Answer 5

ACUTE
resp depresson (opioids)
hyperthermia (stims)
hypothermia (ketamine, alcohol)
hyponatraemia (MDMA)
cardiac symptoms (cocaine, meth)
hepatitis (MDMA)
confusion/delirium (depressants esp. ket)
paranoia/delusion (stims, cannabis)
anxiety attacks (stims/psychs/cannabis)

CHRONIC
liver cirrhosis (alc, ket)
bladder damage (ket)
frontal symptoms (alc, cocaine)
peripheral neuropathy (alc i.e. B1 deficiency)
Wernicke’s encephalopathy (alc i.e. B1 deficiency)
PD (MPTP)

Question 6

How drugs can cause harm from route of use?

Answer 6

• infection (sepsis)
• skin popping
• needle marks
• tooth loss]- “gumming” from amphetamines

Question 7

Describe the burden of alcohol

Answer 7

No health benefit

Main secondary cause of NHS admissions (2006-7)

Main cause of global disability in 15-24 year olds

Most common reason for death in men <50

Costs UK £3 bn
NHS treated 1 million pts for alc-related disorders in 2009

Wide impact on diseases: lip/pharynx/oral cancer, oesoph cancer, colon cancer, rectal cancer, IHD, stroke, cirrhosis, pancreatitis

NB: VERY LARGE cause of liver deaths

cost of booze has decreased over the years

Question 8

Burden of cannabis?

Answer 8

20x increase in cannabis users over last 40 years

Main fear: causes SCZ BUT SCZ’s prevalence is declining

Question 9

Cocaine + alcohol?

Answer 9

-> cocaethylene

Question 10

Most recent approach to estimate drug harms and evaluate this

Answer 10

ISCD Drug Harms Model

• 16 harm criteria
• 20 drugs
• criterion each scored /100 and highest is picked
  |
  alcohol is most harmful drugs (3x worse than cocaine)

Question 11

MCDA (Multiple Criteria Decision Analysis) on nicotine products outcome?

Answer 11

Cigarettes are WAY more harmful than any other product

Cigarettes have highest economic cost in comparison too]- contribute to starting fires (1/2 of all fires in the world)

Strengths:
- After this was published, the same thing was conducted in Europe -> they changed the ranking and weighting -> final results were almost identical

Limitations:

• Data isn’t absolute (numeric)]- but this will never be the case
• Ratings are determined by the experts