The Deliberate Misuse of a Drug - Essay Example

Drug Misuse Introduction: The deliberate misuse of a drug to derive a different effect from which it was originally intended is a menace and prevalent in many societies around the world, particularly those in the developed world including the United Kingdom. Drug misuse is the bane of such societies, as individuals who misuse drugs and become dependent on drugs invariably, destroying personal relations and their health, putting themselves and others in danger and running the potential risk of ending up serving a penitentiary sentence. Controlling and preventing the misuse of drugs has a multi-dimensional perspective to it. The knowledge of drugs and their potential for misuse that pharmacists have, place them in a unique position in any society to identify misuse of drugs and help in its prevention. (1). The Role of the Pharmacist in the Treatment of Drug Misusers: The initial factor in the control and treatment of drug misuse is identification of drug misuse. Identification of drug misuse in the clinical context is not easy, as it could remain atypical, which makes it difficult for physicians to identify. (2). This brings into the picture the pharmacists, who are in a much better position to identify drug misuse and those who misuse drugs, for dispensing of drugs occurs through their hands. The drugs that are liable for misuse are classified into three categories in descending order of relative harmfulness. Class A includes ecstasy, cocaine, heroin, LSD, mescaline, methadone, morphine, opium and the injection forms of the drugs in Class B. Class B consists of oral preparations of amphetamines, barbiturates, cannabis, cannabis resin, codeine and methaqualone. Class C includes benzodiazepines, other less harmful drugs of the amphetamine group and anabolic steroids. (3). Besides these drugs that have been classified based on their harmfulness, other drugs normally used can also be misused like laxatives and antihistamines. Thus the list of drugs liable for misuse is large adding to the difficulty of identification of drug misuse at the clinical level. (4). Pharmacists are present at the point of dispensation with sound knowledge of the dosages at which the use of these drugs are liable for misuse. The records that they maintain on the use of drugs, be it in the prescription form or dispensed over the counter put them in the unique position of being able to identify individuals misusing drugs. (4). Drug misuse was believed to be a problem associated with urban areas in the United Kingdom, but such a concept is no longer valid with evidence emerging that drug misuse has spread into rural areas too, bringing into the picture the relevance of community pharmacists in the treatment of drug misuse (5). Let us examine the manner in which detection of misuse of drugs can be detected by pharmacists at the point of dispensing with the example of methadone, which is on of the frequently misused drugs in the United Kingdom. Methadone has a long duration of action and is an agonist for the mu opioid receptor. Hence it is used in single once daily oral doses for those addicted to opiates, removing the need for further additional opiates. Patients are liable to be given a daily dose initially under supervision at the pharmacy and as the treatment progresses the daily doses are given to be taken at home. This raises the possibility of the misuse of methadone, by selling it in the black market by the patient and the remission to the return to opiate dependency by the purchase of opiates with the money received through the sale of methadone. The pharmacist is in a position to identify such misuse and take the corrective action of return to supervised methadone consumption in the pharmacy and passing on of the information to the (6). In the case of the many other drugs misused, the role of the pharmacist in the treatment of drug misuse does not end with the mere identification of drug misuse. Having identified the misuse the next step in the role of the pharmacist is to use communication and the skills in successful persuasion to get the individual to volunteer for a treatment program and inform the medical professional about this requirement of action. The frequency of interaction and the less formal atmosphere of the pharmacy in comparison to a clinical setting help in this activity. (4). Thus the key points of action in the role of the pharmacist is maintaining strict supervision in the consumption of drugs used for the treatment of drug addiction like methadone and watching out for the possibility of the diversion of these drug to the black market; the maintaining of alertness for misuse of other drugs through a scrutiny of records maintained in the dispensing of drugs through prescriptions; and the recruiting of patient found to be misusing drugs for a suitable treatment program. Three Different Treatment Regimens: Methadone treatment regimen occupies the most prominent place in the treatment of drug misuse. It is available as Methadone mix BNF 1mg/ml. (7). Methadone is a synthetic opioid drug that provides direct relief effectively in the case of opiate withdrawal symptoms. It is ideally used in the case of heroin misuse, even if the dependence has existed for a long period of time. The reason for it being the first line choice of treatment in heroin misuse is that it allows the rapid switching of the heroin misuser on injections to an oral medication with the minimal of withdrawal symptoms, keeping the patient well all day and increasing compliance to the withdrawal of Heroin. The significant point in the methadone treatment is the reduction in the harm potential in drug misuse with the removal of the use of needles and its consequence. However the non-euphoriant property of methadone is relative to that of heroin, and high relapse rates are likely to occur in the methadone treatment regimen. (8). There are several advantages in the use of methadone in the treatment of drug misuse. It has a longer period of activity in normally 24 – 48 hrs, making it easier to achieve stability through daily dosing; titration is straightforward, which helps in achieving correct dosage; has the lower probability for diversion than shorter-acting drugs; chances of injection use are low; and there is evidence to support its use in drug misuse. (7). Long-term maintenance using methadone does not have an adverse effect on the vital organs of the body like heart, lungs, liver, kidneys, bones, blood, brain, and blood. Methadone does cause mild side effects, mostly experienced at the time of initiation of methadone treatment regimen, while the dosage is regulated and these include constipation, water retention, drowsiness, skin rash, excessive sweating and changes in libido. (9). Treatment using methadone begins with a commencement dose based on the potential for opiate toxicity and targets achieving both physical and psychological levels of comfort. The usual initial dosage ranges between 10 – 40 mg daily. A supplementary dosage may be considered, when there is evidence of persistent withdrawal systems extending up to 30 mg. Subsequent to the initial dosing is the stabilization dosage, which may consist of an increase in 5mg to 10 mg per day extending to maximum of 30 mg above the starting dosage in a week. In the subsequent weeks dosages may be increased based on requirement and should not exceed a total of 60 to120 mg. By the end of the sixth week stabilization is normally complete, though in the case of some individuals it may extend even further. Once stability has been established, withdrawal of methadone can be initiated based on the understanding with the patient (7). The main disadvantage with methadone is that with its opiate like qualities, it is a target for misuse itself. (8). Use of lofexidine is another treatment regimen that is approved for opioid withdrawal. However its scope of use is limited to low heroin use, non poly drug users and those patients with a shorter history of drug use or treatment. Besides mild side effects of dry mouth and mild drowsiness there is the issue of caution in the use of lofexidine patients with cardiac disease, cerebro-vascular accidents and chronic renal failure. Its safety for use in pregnant women and breast feeding mothers has not been established. Lofexidine is available as 200 microgram tablets. The initial dosage is one table twice a day, which is increased in gradual steps of 200 to 400 micrograms daily to a maximum of 2.4 mg. The span of stabilization extends for seven to ten days and is withdrawal is initiated, which may extend to four days or more. (7). The advantage with lofexidine is that it can be used in those cases that are not tolerant to methadone and it has a very low probability for misuse itself, however its limited scope of use is its disadvantage. (8). Buprenorphine is another drug with mild opiate properties that is approved for the use of treatment in drug dependence. It is available in sublingual 8mg tablet form. Buprenorphine has an effect that lasts for 24 hrs. Its lower euphoric effects at higher dosage are the cause of its interest singly or in combination with methadone in withdrawal treatment. It is believed to have a lower over dosage potential too, though this is still a subject of research. However these advantages of buprenorphine have been overshadowed with the potential that it requiring strict supervision in its use. Buprenorphine is dissolves easily making it easily misused in the injectable form, which was demonstrated in the high rate of misuse of buprenorphine in the injectable form in the late 1980s in some parts of the United Kingdom (10). Personal Reflection: Identification and treatment of drug misuse is only part of the story in the fight against misuse. The larger picture lies in its prevention and I am not talking of the legal and punitive measures. Preventive measures are at their best, when there is cooperation from all segments of society rich and poor, male and female, young and old. Such cooperation comes from awareness of the pitfalls both for the individual and society through drug misuse. This public awareness arises from education programs conducted at various levels and forums. There is the old adage “catch them young”, which is true in this case too and so education programs on misuse of drugs need to begin at schools, may be at the primary level too. There should be active drug misuse programs at each school and at each level, so that the appropriate education in drug misuse is provided at every level. From schools the right form of educations needs to be extended to all levels of higher education. Expanding these education programs so that every segment of society feels the impact of these programs is necessary. Such an initiative calls for funding and efforts from the part of the governmental authorities on one side and non-governmental agencies on the other side, as the tasks are monumental. Works Cited 1. Wasilow-Mueller, S & Erickson, K. Carlton. “Drug Abuse and Dependency: Understanding Gender Differences in Etiology and Management”. Journal of the American Pharmaceutical Association 41. 1. (2001): 78-90. 2. Mcgrath, A., Crome, P & Crome, I. B. “Substance misuse in the older population”. Postgraduate Medical Journal 81 (2005): 228-231. 3. “DRUG MISUSE AT WORK: a guide for employers”. 2004. HSE. Feb 15. 2008. . 4. Fleming, G. F., McEnlay, J. C. & Hughes C. M. “Development of a community pharmacy-based model to identify and treat OTC drug abuse/misuse: a pilot study”. Pharmacy world & science 26. 5 (2004): 282-288. 5. Holland, R., Vivancos, R., Maskrey, V., Sadler, J., Rumball, D., Harvey, I. & Swift, L. “ The prevalence of problem drug misuse in a rural county of England”. Journal of Public Health 28. 2 (2006): 88-95. 6. “Standards for Supervision of Methadone Consumption in Pharmacies”. GLASGOW ADDICTION SERVICES. Fourth Edition. 2005. NHS. Feb 15. 2008. . 7. “Drug Misuse and Dependence – Guidelines on Clinical Management”. 1999. Department of Health. Feb 15. 2008. . 8. Seivewright, Nicholas. “Community treatment of drug misuse: more than methadone”. Cambridge: Cambridge University Press, 2000. 9. “Methadone”. Office of National Drug Control Policy. 2000. Executive Office of the President. Feb 15. 2008. . 10. “Treating drug misuse problems: evidence of effectiveness”. National Treatment Agency. 2006. NHS. Feb 15. 2008. . 11. Read More