CNS depressants.
CNS depressants are substances that can slow normal brain function. Because of this property, some CNS depressants are useful in the treatment of anxiety and sleep disorders. Barbiturates, which are among the medications that are commonly prescribed for these purposes, such as mephobarbital (Mebaral) and pentobarbital sodium (Nembutal), are used to treat anxiety, tension, and sleep disorders. Benzodiazepines, such as diazepam (Valium), chlordiazepoxide HCl (Librium), and alprazolam (Xanax), which can be prescribed to treat anxiety, acute stress reactions, and panic attacks; the more sedating benzodiazepines, such as triazolam (Halcion) and estazolam (ProSom) can be prescribed for short-term treatment of sleep disorders. In higher doses, some CNS depressants can be used as general anesthetics.
There are numerous CNS depressants; most act on the brain by affecting the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although the different classes of CNS depressants work in unique ways, ultimately it
is through their ability to increase GABA activity that they produce a drowsy or calming effect that is beneficial to those suffering from anxiety or sleep disorders.
During the first few days of taking a prescribed CNS depressant, a person usually feels sleepy and uncoordinated, but as the body becomes accustomed to the effects of the drug, these feelings begin to disappear. If one uses these drugs long term, the body will develop tolerance for the drugs, and larger doses will be needed to achieve the same initial effects.
Continued use can lead to physical dependence and, when use is reduced or stopped, withdrawal. Because all CNS depressants work by slowing the brain’s activity, when an individual stops taking them, the brain’s activity can rebound and race out of control, possibly leading to seizures and other harmful consequences.
Withdrawal from prolonged use of CNS depressants can have life-threatening complications. Therefore, someone who is thinking about discontinuing CNS-depressant therapy or who is suffering withdrawal from a CNS depressant should speak with a physician or seek medical treatment.
CNS depressants should be used with other medications only under a physician’s supervision. Typically, they should not be combined with any other medication or substance that causes CNS depression, including prescription pain medicines, some over-the-counter cold and allergy medications, or alcohol. Using CNS depressants with these other substances, particularly alcohol, can slow breathing, or slow both the heart and respiration, and possibly lead to death.
Stimulants
As the name suggests, stimulants are a class of drugs that enhance brain activity. They cause an increase in alertness, attention, andenergy that is accompanied by elevated blood pressure and increased heart rate and respiration.
Stimulants were used historically to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. But as their potential for abuse and addiction became apparent, the medical use of stimulants began to wane. Now, stimulants are prescribed for the treatment of only a few health conditions, including narcolepsy, attention-deficit hyperactivity disorder, and depression that has not responded to other treatments. In recent years, stimulants that have been sold over the counter as appetite suppressants have been taken off the shelves due to findings of wide-spread abuse and other related side-effects such as heart attack and stroke.
Stimulants, such as dextroamphetamine (Dexedrine) and methylphenidate (Ritalin), have chemical structures that are similar to a family of key brain neurotransmitters called monoamines, which include norepinephrine and dopamine. Stimulants increase the amount of these chemicals in the brain. This, in turn, increases blood pressure and heart rate, constricts blood vessels, increases blood glucose, and opens up the pathways of the respiratory system. In addition, the increase in dopamine is associated with a sense of euphoria that can accompany the use of these drugs.
The consequences of stimulant abuse can be dangerous. Although their use may not lead to physical dependence and risk of withdrawal, stimulants can be addictive in that individuals begin to use them compulsively. Taking high doses of some stimulants repeatedly over a short time can lead to feelings of hostility or paranoia. Additionally, taking high doses of a stimulant may result in dangerously high body temperatures and an irregular heartbeat. There is also the potential for cardiovascular failure or lethal seizures.
Stimulants should be used with other medications only when the patient is under a physician’s supervision. For example, a stimulant may be prescribed to a patient taking an antidepressant. However, health care providers and patients should be mindful that antidepressants enhance the effects of a stimulant.
Patients also should be aware that stimulants should not be mixed with over-the-counter cold medicines that contain decongestants, as this com-bination may cause blood pressure to become dangerously high or lead to irregular heart rhythms.
Role of health care providers
About 70 percent of Americans, approximately 191 million people, visit a health care provider, such as a primary care physician, at least once every 2 years. Thus, health care providers are in a unique position not only to prescribe needed medications, but also to identify prescription drug abuse when it exists and help the patient recognize the problem, set goals for recovery, and seek appropriate treatment when necessary.
Screening for any type of substance abuse can be incorporated into routine history taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why. Screening also can be performed if a patient presents with specific symptoms associated with problem use of a substance. Over time, doctors should note any rapid increases in the amount of a medication needed, which may indicate the development of tolerance, or frequent requests for refills before the quantity prescribed should have been used. They should also be alert to the fact that those addicted to prescription medications may engage in “doctor shopping,” moving from provider to provider in an effort to get multiple prescriptions for the drug they abuse. Preventing or stopping prescription drug abuse is an important part of patient care. However, health care providers should not avoid prescribing or administering strong CNS depressants and painkillers, if they are needed.
It is the responsibility of the doctor who reviews the patients charts to catch any indications that may show discrepancies between amounts needed and amounts prescribed. Too often, because of an over stressed health system, the doctor does not take the time to review charts and many prescriptions and dosages that should be changed are overlooked.
Assessing Prescription Drug Abuse
Four questions to ask:
¨ Have you ever felt the need to Cut down on your use of prescription drugs?
¨ Have you ever felt Annoyed by remarks your friends or loved ones made about your use of prescription drugs?
¨ Have you ever felt Guilty or remorseful about your use of prescription drugs?
¨ Have you Ever used prescription drugs as a way to “get going” or to “calm down?”
Commonly Prescribed Medications: Use and Consequences
Opioids
¨ Oxycodone (OxyContin)
¨ Propoxyphene (Darvon)
¨ Hydrocodone (Vicodin)
¨ Hydromorphone (Dilaudid)
¨ Meperidine (Demerol)
¨ Diphenoxylate (Lomotil)
Generally prescribed for
¨ Postsurgical pain relief
¨ Management of acute or chronic pain
¨ Relief of coughs and diarrhea
Effects of short-term use
¨ Blocked pain messages
¨ Drowsiness
¨ Constipation
¨ Depressed respiration
Effects of long-term use
¨ Tolerance
¨ Physical dependence
¨ Withdrawal symptoms, or addiction
Possible negative effects
¨ Severe respiratory depression or death following a large single dose
Dangerous if used with
¨ Alcohol
¨ Antihistamines
¨ Barbiturates
¨ Benzodiazepines
¨ General anesthetics
¨ Any substance causing CNS depression
CNS DEPRESSANTS
Barbiturates
¨ Mephobarbital (Mebaral)
¨ Pentobarbital sodium (Nembutal)
Benzodiazepines
¨ Diazepam (Valium)
¨ Chlordiazepoxide hydrochloride (Librium)
¨ Alprazolam (Xanax)
¨ Triazolam (Halcion)
¨ Estazolam (ProSom)
Generally prescribed for
¨ Anxiety
¨ Tension
¨ Panic attacks
¨ Acute stress reactions
¨ Sleep disorders
¨ Anesthesia (at high doses)
Effects of short-term use
A “sleepy” and uncoordinated feeling during the first few days, as the body becomes accustomed—tolerant—to the effects, these feelings diminish.
Effects of long-term use
Potential for tolerance, physical dependence, withdrawal, and/or addiction
Possible negative effects
Seizures following a rebound in brain activity after reducing or discontinuing use
Benzodiazapines should not be used with:
¨ Alcohol
¨ Prescription opioid pain medicines
¨ Some over-the-counter cold and allergy medications
Stimulants
¨ Dextroamphetamine (Dexedrine)
¨ Methylphenidate (Ritalin)
¨ Sibutramine hydrochloride monohydrate (Meridia)
Generally prescribed for:
¨ Narcolepsy
¨ Attention-deficit hyperactivity disorder (ADHD)
¨ Depression that does not respond to other treatment
¨ Short-term treatment of obesity
¨ Asthma
Effects of short-term use
¨ Elevated blood pressure
¨ Increased heart rate
¨ Increased respiration
¨ Suppressed appetite
¨ Sleep deprivation
Effects of long-term use
¨ Potential for addiction
Possible negative effects
¨ Dangerously high body temperatures or an irregular heartbeat after taking high doses
¨ Cardiovascular failure or lethal seizures
¨ Hostility or feelings of paranoia after taking high doses repeatedly over a short period of time
Should not be used with
¨ Over-the-counter cold medicines containing decongestants
¨ Antidepression medications
¨ Asthma medications
Steroids (Anabolic)
Anabolic steroids" is the familiar name for synthetic substances related to the male sex hormones (androgens). They promote the growth of skeletal muscle (anabolic effects) and the development of male sexual characteristics (androgenic effects), and also have some other effects. The term "anabolic steroids" will be used through-out this report because of its familiarity, although the proper term for these compounds is "anabolic-androgenic" steroids.
Anabolic steroids were developed in the late 1930s primarily to treat hypogonadism, a condition in which the testes do not produce sufficient testosterone for normal growth, development, and sexual functioning. The primary medical uses of these compounds are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other diseases.
During the 1930s, scientists discovered that anabolic steroids could facilitate the growth of skeletal muscle in laboratory animals, which led to use of the compounds first by bodybuilders and weightlifters and then by athletes in other sports. Steroid abuse has become so widespread in athletics that it affects the outcome of sports contests.
Recent evidence suggests that steroid abuse among adolescents is on the rise. The 1999 Monitoring the Future study, a NIDA-funded survey of drug abuse among adolescents in middle and high schools across the United States, estimated that 2.7 percent of 8th- and 10th-graders and 2.9 percent of 12th-graders had taken anabolic steroids at least once in their lives. For 10th-graders, that is a significant increase from 1998, when 2.0 percent of 10th-graders said they had taken anabolic steroids at least once. For all three grades, the 1999 levels represent a significant increase from 1991, the first year that data on steroid abuse were collected from the younger students. In that year, 1.9 percent of 8th-graders, 1.8 percent of 10th-graders, and 2.1 percent of 12th-graders reported that they had taken anabolic steroids at least once.
Few data exist on the extent of steroid abuse by adults. It has been estimated that hundreds of thousands of people aged 18 and older abuse anabolic steroids at least once a year.
Among both adolescents and adults, steroid abuse is higher among males than females. However, steroid abuse is growing most rapidly among young women.
Affects of steroid abuse
Anabolic steroid abuse has been associated with a wide range of adverse side effects ranging from some that are physically unattractive, such as acne and breast development in men, to others that are life threatening, such as heart attacks and liver cancer. Most are reversible if the abuser stops taking the drugs, but some are permanent.
Most data on the long-term effects of anabolic steroids on humans come from case reports rather than formal epidemiological studies. From the case reports, the incidence of life-threatening effects appears to be low, but serious adverse effects may be under-recognized or under-reported. Data from animal studies seem to support this possibility. One study found that exposing male mice for one-fifth of their lifespan to steroid doses comparable to those taken by human athletes caused a high percentage of premature deaths.
Behavior
Case reports and small studies indicate that anabolic steroids, particularly in high doses, increase irritability and aggression. Some steroid abusers report that they have committed aggressive acts, such as physical fighting, committing armed robbery, or using force to obtain something. Some abusers also report that they have committed property crimes, such as stealing from a store, damaging or destroying others' property, or breaking into a house or a building. Abusers who have committed aggressive acts or property crimes generally report that they engage in these behaviors more often when they take steroids than when they are drug-free.
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