Chasing The Dragon: Drug Use And Abuse

CHASING THE DRAGON:

DRUG USE AND ABUSE

CHASING THE DRAGON:

DRUG USE AND ABUSE

Dr. Budambula Valentine and Prof Budambula L.M Nancy

Copyright © 2017 Dr. Budambula Valentine and Prof Budambula L.M Nancy

Published by Dr. Budambula Valentine and Prof Budambula L.M Nancy Publishing at Smashwords

First edition 2017

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage or retrieval system without permission from the copyright holder.

The Author has made every effort to trace and acknowledge sources/resources/individuals. In the event that any images/information have been incorrectly attributed or credited, the Author will be pleased to rectify these omissions at the earliest opportunity.

Contents

About The Authors

Dedication

Prologue

Definition Of Terms

Chpater One Predictors For Drug Use

Family life

Parental drug use and or drug use by other adults in the family

Low self-esteem

History of early childhood abuse

Personality

Peer pressure

Early aggressive behaviour

Bullying

Gender

Preexisting psychiatric or psychological problem

Low educational level

Gang affiliation and crime

Poverty

Age when substance was first consumed

Neighbourhood environment

Homelessness

Sex workers

Delinquency

Chapter Two Modes of Drug Administration

Systemic Route

Enteral routes

Parenteral routes

Local (topical route)

Conclusion

Chapter Three The Spectrum of Substance

Abuse and Addiction

Drug experimentation stage

Regular use stage

Risky Use Stage

Chemical Dependency Stage

Addiction Stage

SIGNS AND SYMPTOMS OF DRUG ABUSE

Chapter Four The Neurobiology of Addiction

The Neuroanatomy Of Addiction

The Limbic System

Ventral Tegmental Area (VTA)

Medial Forebrain Bundle (MFB)

The Nucleus Accumbens (Nac)

Prefrontal Cortex (PFC)

Locus Coeruleus (LC)

The Amygdala

The Hippocampus (HC)

Mamillary Bodies

Thalamus

Neurons And Neurotransmitters

Classification Of Neurotransmitters

Dopamine (DA)

Serotonin

Norepinephrine (NE)

Epinephrine

Acetylcholine

Endorphin

Anandamide

Glutamate

Gamma-Aminobutyric Acid (Gaba)

Adenosine

Conclusion

Chapter Five Mono And Polydrug Use

Chaper Six Types Of Drugs

Narcotics

Historical Perspective Of Narcotics

Forms Of Heroin

Mode of action of heroin

Signs Of Heroin Use

Withdrawal Symptoms

Stimulants

Amphetamines

Ephedrine

Mode Of Action

Withdrawal Symptoms

Caffeine

Mode Of Action

Withdrawal Symptoms

Nicotine

Mode Of Action

Smoked Tobacco Products

Cigarettes

Cigars And Pipes

Bidis And Kreteks (Clove Cigarettes)

Shisha

Smokeless Tobacco Products

Withdrawal Symptoms

Khat

Mode Of Action Of Khat

Withdrawal Symptoms

Methamphetamines

Mode Of Action Of Methamphetamines

Withdrawal Symptoms

Cocaine

Coca Plant

Cocaine Paste

Powdered Form Of Cocaine (Cocaine Hydrochloride)

Crack Cocaine (Freebase Cocaine)

Mode Of Action

Withdrawal Symptoms

Cannabinoids

Marijuana

Mode Of Action

Withdrawal Symptoms

Benzodiazepines

Rohypnol

Mode Of Action

Withdrawal Symptoms

Alcohol

Mode Of Action

Withdrawal Symptoms Of Alcohol

Hallucinogens

Lysergic Acid Diethylamide (Lsd Or Lsd-25)

Mode Of Action

Lsd Dependence

Withdrawal Symptoms

Phencyclidine (Pcp)

Mode Of Action

Withdrawal Effects

Inhalants

Mode Of Action Of Inhalants

Withdrawal Symptoms Of Inhalants

Anabolic Steroids

Withdrawal Symptoms Of Inhalants

Chaper Seven Social Effects Of Drug And Substance

Use And Abuse

Family And Home Life

Marriage

Stigmatization

Isolation And Rejection

Homelessness

Education

Employment

Health And Wellbeing

Gender Based Effects Of Drugs

Violence

Financial Strain

Other Social Effects Of Drugs

Chapter Eight Comorbities Associated With Substance

Use And Abuse Undernutrition

Reduced Immunity

Tuberculosis

Hiv

Hepatitis

Tetanus

Dermatological Disorders

Chapter Nine Medical Effects Of Recreational

Drug Use

Medical Effects And Clinical Sequelae Of Alcohol Use

Neuropsychiatric Disorders

Cardiovascular Disorders

Gastrointestinal Disorders

Sexual And Reproductive Disorders

Respiratory Disorders

Immunological Disorders

Increased Risk Of Cancers

Intentional And Unintentional Injuries

Others

Medical effects of opiate use

Neuropsychiatric disorders

Cardiovascular disorders

Gastrointestinal disorders

Sexual and reproductive disorders

Respiratory disorders

Immunological disorders

Other effects of opiate

Medical effects of cocaine and

amphetamine-type stimulants (ATS)

Neuropsychiatric disorders

Cardiovascular disorders

Sexual and reproductive disorders

Other effects of cocaine

Medical effects of khat

Neuropsychiatric disorders

Cardiovascular disorders

Gastrointestinal disorders

Sexual and reproductive disorders

Other effects of khat

Medical effects of marijuana

Neuropsychiatric disorders

Cardiovascular disorders

Sexual and reproductive disorders

Immunological disorders

Other effects of marijuana

Medical effects of nicotine

Neuropsychiatric disorders

Cardiovascular disorders

Gastrointestinal disorders

Sexual and reproductive disorders

Respiratory disorders

Immunological disorders

Increased risk of cancers

Others effects of nicotine

Medical effects of benzodiazepine use

Neuropsychiatric disorders

Sexual and reproductive disorders

Medical effects of hallucinogens

Neuropsychiatric disorders

Intentional and unintentional injuries

Other effects of LSD and PCP

Medical Effects Of Anabolic Steroid

Sexual And Reproductive Disorders

Other Effects Of Anabolic Steroids

Medical Effects Of Inhalants

Chapter Ten The Modus Operandi Of The Drug World

Drugs Fuel Crime

Psychopharmacological Crimes

Economic Related Crimes

Systemic Crimes

Criminal Activities Encourage Drug Use And Abuse

Drug Law Offences

Chaper Eleven Prevention Of Drug Use And Abuse

Demand Reduction

Supply Reduction

Parenting skills and familial stability

Wealth creation and poverty reduction

Supply reduction

Chapter Twelve Management Of Drug Addiction

Stis Treatment, Hiv Testing And Linkage

Targeted Educational Interventions

Harm Reduction

Syringe And Needle Syringe Programmes (Snep)

Safe Injecting Facilities (Sif)

Oral Substitution Therapy (Ost)

Treatment For Stimulant Dependence

Rehabilitation

Challenges In Combating Drug Use And Abuse Harm Reduction

Lack Of Comprehensive Services

Adherence To Treatment

Drug Interaction

Rehabilitation Centres

Drug Legislation

Outdated Strategies

Epilogue: Dear Child

Epilogue: Dear Parent

Bibliography

ABOUT THE AUTHORS

This book is written by two sisters who are career academics. Although they pursued different research interests, their common interest in drugs would later bring them together to write this book.

Valentine Budambula holds a PhD in Epidemiology and is a lecturer in a public university in Kenya. At the time of writing this book she had taught for over eight years at university level. Her work on addiction epidemiology has been widely published by leading publishers in diverse peer reviewed journals.

Nancy Budambula is an associate professor of microbiology in a public university in Kenya. At the time of writing this book she had taught for over twenty years at university level. She has diverse research interests including microbiology, virology, genetics and drugs. Her work has been published in many international peer reviewed journals by top publishers.

Two of the chapters in the book have been contributed by Dr Muraya Gathinji, a practicing medical doctor trained at John Hopkins University. He also holds a BA and MSc degrees from the same university. His work in neurology is well published.

Citation: Budambula V. and Budambula N.L.M. (2017). Chasing the Dragon: Drug Use and Abuse.

Corresponding author: valbudambula@gmail.com

DEDICATION

This is a special dedication to our parents.

To our father, the late Aaron Leonid Budambula, Baccalaureus Artium (BA). Degree awarded on the 9th day of October in the year of our Lord 1971 at Makerere University, Kampala campus. Dad believed in girl child education. His dream and name will never die, for he educated the girl child. He left a legacy. Sunrise: 22nd April 1942. Sunset: 16th December 1987. Dad, Rest in Peace.

To our no nonsense mother Zerephata, the matriarch of the Budambula dynasty. She made sure we obeyed all the rules at home and in school. She always had an extra eye fitted with a pair of binoculars. Her wisdom, courage and generosity astonish many. We salute you for carrying the mantle and implementing dad’s vision.

PROLOGUE

Chasing the dragon is a bit more complicated than merely smoking heroin. It starts when you have your first high, the world is peaceful, everything is perfect and you get numb. Soon, it starts wearing off. Fast. Your brain races and you are pulled out of your new dream world. You crave for the drug. Again and again, longing to experience this newly found world. You go to the dealer and buy the same amount you had the first time and smoke. Yes, it feels good, but not as good as first time. You go back and buy more. More and more again, yeah, you feel closer, but not quite there. You want to go back to that little dream world and stay forever. By now your body is already developing tolerance. You boost the effect by either topping up with another drug or changing the mode of administration. From smoking you graduate to injecting and from one drug you experiment with several. By now you have upgraded from a monosubstance user to polysubstance user. You use more and more money to buy more and more drugs, but still it is not the same as that first time. Suddenly, you realize that you have no more money. You panic but the craving is persistent so you start selling your things and pawning whatever can get hold of. Still, nothing can be compared to what you had on that first memorable and magical day. By now you are broke, own nothing and truly enslaved by two masters, the drug and your brain. You no longer care because all you want is to get back to the first high. You start stealing and doing favours as long as you get the money or the drug for the attempt. You are ready to engage in sex in exchange for drugs or money or both. Your life becomes a living hell- hopeless, meaningless and valueless. It is all vanity, and vanity of vanities is vanity. It is like chasing the wind. Now, that is chasing the dragon (adopted and modified from Prawn, 2004).

DEFINITION OF TERMS

Abstinence: Refraining from drug use or drinking alcoholic beverages for health, personal, religious, social, moral, legal or any other reason(s).

Addiction: It is derived from a Latin term for enslaved by or bound to. Addiction is the repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated. Moreover, the addict shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use and exhibits determination to obtain psychoactive substances by almost any means. It can also be defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain structure and function. These brain changes can be long lasting and can lead to harmful and often self-destructive behaviours.

Adrenaline: Also known as epinephrine, adrenaline is a hormone (chemical messenger) that is released in response to fear, anger, panic and other emotions. It readies the body to respond to threat by increasing heart rate, breathing rate, and blood flow to the arms and legs. These and other effects prepare the body flight or fight, whatever is wise.

Alcoholism: The chronic continual drinking or periodic consumption of alcohol which is characterized by impaired control over drinking, frequent episodes of intoxication, preoccupation with alcohol and the use of alcohol despite adverse consequences.

Amnesia: Loss or disturbance of memory (complete or partial, permanent or temporary).

Amygdala: Amygdala (plural amygdalae) is the integrative center for processing of memory, emotions, emotional behaviour, decision-making and motivation. It is considered as part of the limbic system (a complex set of brain structures located on both sides of the thalamus, right under the cerebrum).

Binge drinking: A pattern of heavy drinking that occurs in an extended period set aside for the purpose. Alternative terms include bout drinking and spree drinking.

Blackout: Acute amnesia, not associated with loss of consciousness, resulting from the ingestion of alcohol or other substances; a period of memory loss during which there is little if any recall of activities.

Come-down: The gradual wearing off of the effects of a drug after a high.

Co-morbidity: The occurrence of two disorders or illnesses in the same person; also referred to as co-occurring conditions or dual diagnosis. Patients with co-morbid illnesses may experience a more severe illness course and require treatment for each or all conditions.

Craving: A powerful and often uncontrollable desire for drugs.

Delirium: An acute organic cerebral syndrome characterized by concurrent disturbances of consciousness, attention, perception, orientation, thinking, memory, psychomotor behaviour, emotion and the sleep-wake cycle.

Dependence: The state of needing something or someone for support or to function or survive. As applied to alcohol and other drugs, the term implies a need for repeated doses of the drug to feel good or to avoid feeling bad.

Dopamine: A brain chemical (produced naturally by certain brain cells) classified as a neurotransmitter. It is found in regions that regulate movement, emotion, motivation, and pleasure. Specific drugs may block specific effects of dopamine, act like dopamine at specific receptor sites or increase the availability of dopamine.

Doping: Defined by the International Olympic Committee and the International Amateur Athletic Federation as the use or distribution of substances that could artificially improve an athlete’s physical or mental condition, and thus his or her athletic performance.

Drinking: Ingestion of a beverage; specifically, in the present context, of an alcoholic beverage.

Drink spiking: The practice of adding alcohol or another substance to a drink without the knowledge of the person who will be consuming it. The effects depend on the type and quantity of the additive used and can include vomiting, loss of consciousness, respiratory difficulties and loss of control. Drink spiking is illegal in Kenya.

Drug abuse: The harmful or hazardous use of psychoactive substances for mood-altering purposes. It can also be defined as the use of illicit drugs or the abuse of prescription or over-the-counter drugs for purposes other than those for which they are indicated or in a manner or in quantities other than directed. Abused substances produce some form of intoxication that alters judgment, perception, attention, or physical control and causes addiction.

Drunk-driving: The generally favoured term for the criminal action of driving a vehicle with a blood alcohol level above a specified limit.

Flashbacks: Episodes of short duration (seconds to hours) spontaneous recurrence of the visual distortions, physical symptoms, loss of ego boundaries or intense emotions. Flashbacks may duplicate exactly the symptoms of previous hallucinogen episodes.

Hangover: A post-intoxication state comprising the immediate after-effects of drinking alcoholic beverages in excess. Physical features may include fatigue, headache, thirst, vertigo, gastric disorder, nausea, vomiting, insomnia, fine tremors of the hands, and raised or lowered blood pressure. Psychological symptoms include acute anxiety, guilt, depression, irritability and extreme sensitivity.

Illicit drug: A psychoactive substance whose production, sale or use is prohibited. May also refer to the production, distribution and sale of any drug outside the legally sanctioned channels.

Impaired judgment: the inability to make sound decisions.

Intoxication: A condition that follows the administration of a sufficient amount of a psychoactive substance and which results in behavioural and/or physical changes. The capacity to think and act within a normal range of ability diminishes.

Passive smoking: The involuntary inhalation of smoke, usually tobacco smoke, from another person’s smoking.

Poly drug use: The concurrent or sequential abuse of more than one drug or type of drug, with dependence on at least one and usually with the intention of enhancing, potentiating or counteracting the effects of another drug.

Prohibition: Policy under which the cultivation, manufacture and/or sale (and sometimes the use) of a psychoactive drug are forbidden (although pharmaceutical sales are usually permitted).

Recreational drug use: Utilization of a drug, usually an illicit drug, in social (non-medicinal) or relaxing circumstances.

Relapse: A return to drinking or other drug use after a period of abstinence often accompanied by recurrence of dependence symptoms.

Rush: A surge of euphoric pleasure that rapidly follows administration of a drug.

Serotonin: A neurotransmitter created by the human body (found in the gastrointestinal tract, blood platelets and the central nervous system). It influences physiological processes like mood (for example depression and anxiety) and social behaviour, appetite and digestion, sexual desire and function in addition to sleep and memory.

Tolerance: A decrease in response to a drug dose that occurs with continued use. Increased doses of alcohol or other drugs are required to achieve the effects originally produced by lower doses.

Withdrawal syndrome: A combination of signs and symptoms of variable clustering and degree of severity which occur on sudden cessation or reduction of use of a psychoactive substance that

has been taken repeatedly, usually for a prolonged period and/ or in high doses.

Chapter One

Predictors for Drug Use

Drug abuse refers to the harmful or hazardous use of psychoactive substances for mood-altering purposes. It can also be defined as the use of illicit drugs or the abuse of prescription or over-the-counter drugs for purposes other than those for which they are indicated or in a manner or in quantities other than directed. Addiction is the repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means. Addiction can also be defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain, its structure and how it works. These changes can be long lasting and harmful, often leading to self-destructive behaviours. Although drug abuse knows no boundaries as persons of any age, gender or economic status, certain factors increase the likelihood of one using drugs or developing an addiction. Most of these factors revolve around the family.

Family life

In every conceivable manner, family is the link to the past and bridge to the future. Although alcohol or drug use is a personal choice, familial history combined with current behaviour tendencies in the home largely influences the risk of drug use and subsequent dependence. Heredity is a major risk factor for addiction. It is estimated that 40 to 60 percent of a person’s risk for addiction is based on genetics. Therefore, alcoholism and drug dependence are genetic and social disorders. If one has a blood relative, such as a parent or