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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Overview of Drugs
Citation: http://resize0.indiatvnews.com/en/centered/newbucket/750_533/2016/03/
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Therefore, education and outreach are key in helping people understand the possible
risks of drug use. Teachers, parents, and health care providers have crucial roles in
educating young people and preventing drug use and addiction.
■ Drug addiction is a chronic disease characterized by drug seeking and use
that is compulsive, or difficult to control, despite harmful consequences.
■ Brain changes that occur over time with drug use challenge an addicted
person’s self-control and interfere with their ability to resist intense urges
to take drugs. This is why drug addiction is also a relapsing disease.
■ Relapse is the return to drug use after an attempt to stop. Relapse indicates
the need for more or different treatment.
■ Most drugs affect the brain’s reward circuit by flooding it with the chemical
messenger dopamine. This overstimulation of the reward circuit causes the
intensely pleasurable “high” that leads people to take a drug again and
again.
■ Over time, the brain adjusts to the excess dopamine, which reduces the
high that the person feels compared to the high they felt when first taking
the drug an effect known as tolerance. They might take more of the drug,
trying to achieve the same dopamine high.
■ No single factor can predict whether a person will become addicted to
drugs. A combination of genetic, environmental, and developmental factors
influences risk for addiction. The more risk factors a person has, the greater
the chance that taking drugs can lead to addiction.
■ Drug addiction is treatable and can be successfully managed.
■ More good news is that drug use and addiction are preventable. Teachers,
parents, and health care providers have crucial roles in educating young
people and preventing drug use and addiction.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Crude Drug
A crude drug is naturally occurring drug with pharmacologically active ingredients in
an unrefined state, requiring no additional processing for use. An example is ginseng
root; patients can consume fresh or dried roots straight in addition to grinding them
into powder for use in capsules, teas, and other preparations. The root is ready to
use as it comes out of the ground, in contrast with other botanical pharmaceuticals
that may require processing to extract useful compounds. Traditional medicine in
many cultures relies heavily on crude drugs to treat patients.
Citation: http://images.wisegeek.com/large-blue-pills-spilling-out-of-bottle.jpg
Leaves, flowers, roots, and whole plants can be crude drugs, as can other living
organisms. Some crude drugs are found in fungi, lichens, or even rocks. In all cases,
it is possible to collect the drug in nature and use it as is. Some crude drugs may
be cultivated to provide a controlled and readily accessible supply of the drug for
use. Most can be dried or otherwise preserved to make it possible to store reserves,
rather than having to rely on fresh sources of a crude drug.
Doctors can prescribe a plain crude drug or prepare it to make it easier to take.
These crude drug can be made into teas, capsules, syrups, and other pharmaceutical
products. Their shelf life varies, depending on handling. Usually they need to be
kept in a cool, dark, dry place to retain potency. Traditional Chinese medicine
(TCM) calls for crude drugs, as do ayurveda and other traditional medical practices
from cultures all over the world.
The drawback of using a crude drug is inconsistency with dosing and quality
control. Potency of herbs, for example, can vary on where and how they grow,
the handling of the herb during harvesting and storage, and other factors. This
makes prescribing challenging, as it is not possible to determine the dosage without
Overview of Drugs
expensive testing of each individual plant, so doctors need to estimate on the basis
of the average potency. Some more advanced pharmaceuticals are derived from
crude drugs, while others were developed first by refining crude drugs, and then
developing a synthetic formula to make the biologically active ingredient without
having to refine natural ingredients.
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Citation: http://images.wisegeek.com/tipped-bottle-of-pills.jpg
In conventional medicine, the use of crude drugs is rare, as doctors prefer more
reliable medications for patient treatment. Some doctors are willing to work with
them as a form of complementary medicine, and can help patients find herbs and
other treatments to take as an adjunct to existing treatment. Others may prefer not
to use such medications at all. One thing for patients to be aware of with crude
drugs is that they can interact adversely with each other as well as with conventional
medicines, potentially reducing efficacy or causing serious side effects.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
DEFINITIONS OF DRUG AND ALCOHOL PROBLEMS
Problematic drug use has been formally categorized in some systems as:
■ hazardous use
■ harmful use
■ substance abuse
■ substance dependence
Hazardous Use
Hazardous use refers to a pattern of substance use that increases the risk of harmful
consequences for the user. These consequences can include physical and/or mental
health problems; some would also include social consequences. Hazardous use
refers to patterns of use that are of public health significance despite the absence
of any current disorder in the individual user.
Substance ‘Abuse’
Substance ‘abuse’ is a term used by DSM– IV–TR. It is defined as a maladaptive
pattern of substance use leading to clinically significant impairment or distress, as
manifested by one or more of the following, occurring within a 12 month period:
■ Failure to fulfil major role obligations
■ Use in situations in which it is physically hazardous
■ Recurrent substance-related legal problems
■ Continued use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of the substance
Unlike dependence, ‘abuse’ is not characterised by withdrawal, tolerance or a
pattern of compulsive use, only the adverse consequences of repeated use.
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Overview of Drugs
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Substance Dependence
Substance dependence on the other hand, is defined as a characteristic set of
cognitive, behavioural and physiological signs in which the individual will continue
to use the substance despite considerable related problems. Tolerance has developed
and withdrawal symptoms are present upon cessation of the drug.
In addition to these criteria, the World Health Organization (WHO) International
Classification of Diseases, suggests that another essential characteristic of dependence
is that the individual must possess a strong desire to take the substance and is
indeed consuming it. It is important to note that many problems associated with
the use of alcohol or other psychoactive drugs do not involve dependence. That
is, you do not need to be dependent on a drug to experience harms from its use.
Standards of Care
The standard of care is the only degree of prudence and caution required of an
individual who is under a duty of care. The requirements of the standard are closely
dependent on circumstances. Whether the standard of care has been breached is
determined by the trier of fact, and is usually phrased in terms of the reasonable
person. It was famously described in Vaughn v. Menlove as whether the individual
“proceed with such reasonable caution as a prudent man would have exercised
under such circumstances”.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Attitudes Towards Drug Users
Psychoactive drug users often experience discrimination and stigma when accessing
health services. While not all health professionals discriminate against drug users,
poor treatment and discriminatory practices have been identified as primary barriers
to accessing health care.
Negative attitudes are often based on stereotypes and fears. Such stereotypes
can result in discrimination, stigma and marginalisation. Like other groups in the
community, drug users are a diverse group with differing needs and backgrounds.
In the health care context, recognising the diverse needs of every individual is
critical to professional and effective treatment and ensures appropriate standards
of care are met.
Drug Users’ Rights
Treating all illicit drug users as ‘drug seeking’, unreliable and disruptive will not
result in a positive outcome for either the person who uses drugs or the health
professional. Participation in an illegal behaviour does not mean that individuals
surrender their basic health and human rights. Illicit drug users should be treated in
the same way as other people, that is, as individuals with specific needs requiring
information and communication on all options, professional diagnosis and where
appropriate, treatment.
Citation: https://paradigmmalibu.com/wp-content/uploads/2013/09/drugs.jpg
Role of Health and Human Services Providers
The U.S. Department of Health and Human Services (HHS) is the U.S. government’s
principal agency for protecting the health of all Americans and providing essential
human services, especially for those who are least able to help themselves.
Overview of Drugs
HHS is responsible for almost a quarter of all federal outlays and administers more
grant dollars than all other federal agencies combined. The Department manages
programs that cover a vast spectrum of activities that impact health, public health,
and human services outcomes throughout the life span.
HHS, through its programs and partnerships:
■ Provides health care coverage to more than 100 million people through
Medicare, Medicaid, the Children’s Health Insurance Program, and the
Health Insurance Marketplace;
■ Promotes patient safety and health care quality in health care settings and
by health care providers, by assuring the safety, effectiveness, quality, and
security of foods, drugs, vaccines, and medical devices;
■ Eliminates disparities in health, as well as health care access and quality,
and protects vulnerable individuals and communities from poor health,
public health, and human services outcomes;
■ Conducts health, public health, and social science research with the
largest source of funding for medical research in the world, while creating
hundreds of thousands of high-quality jobs for scientists in universities and
research institutions in every state across America and around the globe;
■ Leverages health information technology to improve the quality of care
and use HHS data to drive innovative solutions to health, public health,
and human services challenges;
■ Improves maternal and infant health; promotes the safety, well-being, and
healthy development of children and youth; and supports young people’s
successful transition to adulthood;
■ Promotes economic and social well-being for individuals, families, and
communities, including seniors and individuals with disabilities;
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■ Supports wellness efforts across the life span, from protecting mental health,
to preventing risky behaviors such as tobacco use and substance abuse,
to promoting better nutrition and physical activity;
■ Prevents and manages the impacts of infectious diseases and chronic diseases
and conditions, including the top causes of disease, disability, and death;
■ Prepares Americans for, protects Americans from, and provides comprehensive
responses to health, safety, and security threats, both foreign and domestic,
whether natural or man-made; and
■ Serves as responsible stewards of the public’s investments.
The HHS Strategic Plan FY 2014-2018 includes strategic goals and associated
objectives, strategies, and performance goals that focus on these and other major
functions of the Department.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Medical Practitioners and Nurses
Medical practitioners and nurses who are not specialists in drug and alcohol have
a critically important role to play in the provision of drug and alcohol treatments.
General practitioners and other primary care health professionals are particularly
well suited for this role because:
■ 85% of the population visit a general practitioner at least once per year
■ General practitioners and primary health professionals are usually the first
point of contact with the health care system
■ Patients are often at a learning moment and expect to receive lifestyle
advice from general practitioners
■ General practitioners are in an ideal position to link prevention with
comprehensive, continuing and holistic care
■ General practitioners provide a range of services that span the health care
continuum from prevention of illness to treatment and rehabilitation
Medical practitioners and nurses are ideally placed to:
■ provide relevant information about drugs and alcohol to all patients
■ identify drug- and alcohol-related problems
■ provide interventions
■ refer for specialist assessment and treatment when required; and
■ coordinate care and follow up patients over
■ time
There is a growing body of evidence about the effectiveness of interventions and
benefits of treatment that medical practitioners and nurses can provide.
Overview of Drugs
These include:
■ Screening
■ Assessment
■ Information and advice
■ Brief interventions for tobacco, alcohol and to a lesser extent cannabis
■ Detoxification, including home detoxification
■ Pharmacotherapy for tobacco, alcohol and opioid dependence
■ Counselling, including motivational interviewing, and relapse prevention
■ Referral to clinicians with specialist skills in drug and alcohol
■ Follow-up monitoring and care coordination
These interventions have been shown to be effective in specialist and non-specialist
settings.
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For clinicians with specific drug and alcohol competencies, a more comprehensive
role in the care of patients can be undertaken including:
■ Management of intoxication and withdrawal
■ Motivational interviewing
■ Management of detoxification
■ Pharmacotherapy treatments
■ Counselling
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■ Treatment of medical comorbidities
■ Management of psychiatric comorbidities
■ Care of pregnant women with drug- and alcohol-related problems and
their neonates; and
■ Follow-up monitoring and review
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Other Frontline Workers
The complexity and diversity of problems associated with alcohol and drug use has
increased substantially over the past decade. The potential support and intervention
roles for health and human services workers has increased accordingly. Evidence
for the efficacy of early intervention has been well established and identifies an
important role for any professional in a position to intervene for alcohol and drug
problems.
Key professional groups identified as pivotal frontline workers include:
■ alcohol and other drug specialist workers
■ general health workers such as medical practitioners, nurses, Indigenous
health workers and psychologists
■ volunteer workers in a variety of community groups including parent and
family groups, self-help groups, church groups and counselling support
groups
■ police and law enforcement personnel
■ welfare professionals, including social workers, youth workers and other
community-based workers
■ teachers and education personnel
It is no longer assumed that support and intervention for alcohol and other drug (AOD)
problems is the exclusive province of specialist professionals. While interventions
and treatments have become more specific and technical in recent years (most
notably in relation to pharmacological interventions) there is also an expanded role
for generalist frontline workers especially from a prevention, harm minimisation and
early intervention perspective.
Health Professionals’ Role with Aboriginal and Torres Strait Islanders
There is a range of special considerations in relation to the AOD use of Indigenous
Australians. Patterns and correlates of use are often quite different and health care
needs more complex than for the wider community. Proportionately fewer Indigenous
people drink than in the Australian community at large. However, amongst those
who consume alcohol the majority do so at hazardous and harmful levels, often
drinking heavily on a single occasion. There is often intense social pressure for
Indigenous drinkers to continue to drink. Relatedness to others is deeply embedded
within Aboriginal social life and sharing alcohol (and increasingly other drugs)