Subtance Abused

7/30/2019 Subtance Abused

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Subtance abused

psikotropika dan narkotika

Prof. Moch Aris Widodo PhD

PPD UNISMA


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PSIKOTROPIKA

DEPRESANT

STIMULANT

ALKOHOL

HALUCINOGENNARCOTIKA

MARIHUANA / GANJA

COBA COBARECREATIONAL

PENGOBATAN

DIPAKSA

ADAPTASI SEL NEURON

TOLERANCE

KEMATIAN SEL NEURON

DEGENERASI NEURON

AKUT KEMATIAN

KETERGANTUNGAN

FISIK PSIKIS

ADDICTION

WITHDRAWL SYMPTOM

STRESS

BROKEN HOME


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Penggunaan obat psikotropika dan narkotika

Menyebabkan keracunan akut pda dosis berlebihan

Gangguan pada fungsi CNS dan Fungsi kardio vasculer

Dengan gejala gejala sesuai dengan siat psikotropika / narcotika

Menyebabkan kematian

Penggunaan psikotropika dan narcotika

Tolerance addiction / dependenceWithdrawal symptom


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drugs user

environment

Drug

Abuser

addict

ADDIKSI TERHADAP OBAT ADALAH PENGGUNAAN OBAT YANG

BERULANG, PENGGUNAAN OBAT MENJADI PRIORITAS UTAMA DIATAS

KEPENTINGAN YANG LAIN , TANPA MENGHIRAUKAN EFEK NEGATIF OBAT

TERSEBUT,DAN LEBIH MEMENTINGKAN MENGKONSUMSI OBAT

DIBANDINGKAN KEPERLUAN YANG LAIN


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CRITERIA FOR DRUG DEPENDENCE/ ADDICTION

Primary criteiahighly controled or compulsive use

psychoactive effect

drug reinforced behavioor

Additional criteria

addictive behavior often involvesstereotypical pattern of use

used depite harmful effects

relaps following abstinence

recurrent drug cravings

Dependence producing drug often produce

tolerancephysical dependence

pleasant euphorian effects


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Agent (Drug) Variables.Obat psikotropika bervariasi dalam menyebabkan efek euphoria, obat

yang menyebabkan perasaan menyenangkan bagi pengguna sering kali

digunakan secara berulang ulang.

REINFORCEMENT adalah kemampuan suatu obat untuk keinginan

untuk menggunakan kembali obat tersebut. Semakin kuat reinforcmentsuatu obat semakin sering disalah gunakan.

Sifat reinforceent ini terjadi oleh karena kemamuan obat untuk

meningkatkan aktivitas neuron pada daerah otak tertentu

Cocaine, amphetamine, ethanol, opioids, cannabinoids, and nicotinesemuanya menyebabkan peningkatan kadar dopamine pada ventral

striatum terutama pada daerah nucleus nucleus accumbens


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HOST USER

TERDAPAT VARIASI RESPON PENGGUNA OBAT OBAT

PSIKOTROPIKA DAN NARKOTIKA

RESPON BERBEDA WALAU DOSIS YANG DIGUNAKAN SAMA

HAL INI OLEH KARENAKADAR OBAT DALAM PLASMA BERBEDA

ADA POLIMORPHISME DARI GEN YANG MENGKODE

ENZIM YANG TERLIBAT DALAM

ABSORBSI,METABOLISM DAN EKRESI

RESPON AKIBAT IKATAN OBAT DENGAN RESEPTOR

TOLERANCEPENGALAMAN PENGGUNAAN YANG MENYENAGKAN PADA

PERISTIWA TERTENTU SPRTIMEROKOK SETELAH MAKAN


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Environmental Var iables.

Awal penggunaan dan penggunaan secara illegal selanjutnya sangat

dipengaruhi oleh lingkungan dimana pengguna berada. Penggunan

awal obat nampaknya sebagai upaya melawan keteraturan,

dipengaruhi olehperubahan norma sosial, atau akibat tekanan

Pada suatu communitas pengguna obat psikotropik dan narkotik

dianggap sebagai orang sukses dan sebagai panutan yang dihormati,

oleh masyarakatnya terutama pemuda edukasi rendah dan tanpa

pekerjaan.


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TOLERANCE

Respon yang terjadi pada penggunaan obat psikotropika /

narcotica secara berualng ulang adalah efek yang semakin berkurang

untuk mendapatkan efek yang sama diperlukan dosis yang meningkat

atau menggunakan obat sejenis yang lebih kuat atau obat lain yang

efeknya lebih poten

Contoh adalah diazepam pada awalnya dengan dosis 5-10mg memberikan

efek sedasi ketenangan , namun apabila dilakukan dosis yang berulang

efek yang dihasilkan berkurang dibutukan ratusan mg untuk mendapatkan

efek yang sama bahkan ada pengguna diazepam yang membutuhkan

lebih 1000 mg / hari

Tolerance terjadi lebih cepat untuk obat yang menyebabkan euphoria

seperti heroin, sebaliknya tolerance pada efek opiate pada

gastrointestinal terjadi lebih lambat. Emikian pula tolerance terhadap

fungsi vital seperti tekanan darah dan pernapasan terjadi lebih lambat.,


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TOLERANCE

UNTUK MENDAPATKAN EFEK YANG SAMA DIBUTUHKAN

DOSI YANG LEBIH BESARINNATE TOLERANCE

TOLERANCE YANG SECARA GENETIK DITURUNKAN

ACQUIRED TOLERANCE

PARMAKOKINETIK : TOLERANCE OK PERUBAHAN ABSORBSI,

METABOLISM, DAN EKSKRESI OBAT

PHARMACODYNAMIC : TOLERNCE YANG TERJADI OLEHKARENA PERUBAHAN RESEPTOR /KEPADATANNYA

LEARNED TOLERANCE: TOLERANCE YANG TERJADI AKIBAT

MEKANISME KOMPENSASI FISIOLOGIS AKIBAT

PEGALAMAN EFEK OBAT YANG LALU

CROS TOLERANCE: TOLERANCE TERHADAP SUATU OBAT JUGA TER

JADI PADA PENGGUNAAN OBAT YANG LAINACUTE TOLRANCE : TOLERANCE YANG TERJADI SANGAT SINGKAT,

DALAM BEBERAPA JAM PENGGUNAAN


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Physical Dependence

Suatu keadaan yang berkembang akibat proses adaptasi neuron dan perubahan

homeostasis /terjadi homeostasis yang baru karena penggunaan obat

psikotropika atau narcotika yang berulang.

Akibat adanya obat tersebut terjadi keseimbangan baru bebagai sistem dalam

tubuh, untuk mempertahankan sistem baru tersebut diperlukan stimulasi dari obattersebut .

Apabila penggunaan obat tersebut dihentikan mendadak akan terjadi ketidak

seimbangan sistem akan berupaya untuk membentuk keseimbangan baru tanpa

obat dan ini sering menimbulkan ketidak nyamanan


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Adiksi terhadap suatu obat

neuroadaptation

Peggunaan terhenti

Proses maladaptive

Timbul gejala withdrawal

Gejala sebaliknya dari efek obat

Narcotika

Agitasi, eksitasi, alkoholDehidrasi, nyeri hebat narkotik

kematian


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Penduduk pegunungan andes di amerika selatan, menguyah daun coca

untukmendapatkan efek meningkatkan stamina namun jarang terjadi

penyalah gunaan dan ketergantungan oleh karena mengunyah daun kokapenyerapan lambat, kadar cocain dalam darah secara pelan pelan

meningkat demikian pula dengan kadar cocain diotak.

Pada akhir abad 19 ilmuwan mengisolasi cocain hydrochlorida dari daun

coca, pembuatan ektract cocain secara besar besaran serbuk kokain

dapat digunakan dengan menelan, penyerapan melalui mukosa hidung,penyuntikan inravena menyebabkan kadar cocain dengan cepat

meningkat didarah dan diotak sehingga terjadi efek stimulasi,dan semakin

menybabkan terjadinya ddiction.

CRACK COCAIN ADALAH ALKALOID KOKAIN DALAM BENTUK BASA

BEBAS, YANG HARGANYA MURAH DAN DIGUNAKAN DENGANMEGHIRUP UAPNYA (SETELAH DICAMPUR AIR PANAS ) SAMA CARA

PEMAKAIANNYA DENGAN NICOTIN DAN MARHUANA

Penyalahgunaan obat tergantung pada kecepatan peningkatan kadar obat

Di otak misalnya COCAINE


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Withdrawal Syndrome.

sinderoma yang taerjadi akibat pemutusan obat

merupakan bukti adanya phsical depndence

terjadi akibat tidak digunakannya obat

proses hyperarosal akibat readaptasi neuron

Withdrawal symptoms are characteristic for a given category of drugs and

tend to be opposite to the original effects produced by the drug before

tolerance developed.

Thus, abrupt termination of a drug (such as an opioid agonist) that

produces miotic (constricted) pupils and slow heart rate will produce a

withdrawal syndrome including dilated pupils and tachycardia.

Tolerance, physical dependence, and withdrawal are all biological

phenomena


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OBAT YANG MENDEPRESI CNS


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Ethanol.

More than 90% of American adults report experience with ethanol (commonly

called alcohol), and approximately 70% report some level of current use. Thelifetime prevalence of alcohol abuse and alcohol addiction (alcoholism) in this

society is 5% to 10% for men and 3% to 5% for women.

Ethanol is classed as a depressant because it indeed produces sedation and

sleep. However, the initial effects of alcohol, particularly at lower doses, often are

perceived as stimulation owing to a suppression of inhibitory systems

Alcohol impairs recent memory and, in high doses, produces the phenomenon of

"blackouts," after which the drinker has no memory of his or her behavior while

intoxicated. The effects of alcohol on memory are unclear, but evidence suggests

that reports from patients about their reasons for drinking and their behavior

during a binge are not reliable.

Alcohol dependent persons often say that they drink to relieve anxiety or

depression. When allowed to drink under observation, however, alcoholics

typically become more dysphoric as drinking continues thus not supporting the

idea that alcoholics drink to relieve ANXIETY


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Benzodiazepines.

Banyak diresekan digunakan secara luas jarang disalah gunakan obat

ini digunakan untuk mengobati anxiety dan insomnia

Benzodiazepin onset cepat adalah diazepam, alphrazepam

Penggunaan bebrapminggu jarang menyebabkan tolerance dan tidak

sulit menghentikan obat

Penggunaan beberapa bulan menyebabkan tolerance penghentuian

obat menyebabkan gejala withdrawal

Penderita dengan riwayat penyalah gunaan obat tau pengguna alkohol

meningkatkan kemungkinan penyalah gunan obat ini

Penyalahguna obat ini sring mengkmbinasikan dengan obat lain untuk

meningkatkan efek misalnya menggunakan menggunakan diazepam 30

menit sebelum methadone meningkatkan efek HIGH yang tidak dapat

diperoleh dengan menggnakan obat sendiri sendiri.


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Nicotine

menyebabkan ketergantungan dibuktikan walaupun 80% ingin berhenti

merokok namun tidak berhasil

Cigarette (nicotine) :addiksi tergantung pada beberapa variabel. Nikotin

menyebabkan reinforcment, seperti penggunaan cocain atau

amphetamin walaupun derajat rendah.

satu hiasapan menyebabkan reinforcment. Dengan 10 hisapan /rokok

dan 1 pak perhari menyebabkan reinforcment meningkat 200

Nicotine mempunyai efek stimulant dan depresant , pengguna

merasakan adanya keaspadaan dan relaksasi otot , nicotine

mengaktifkan nukleus accumben sistem reward di otak meningkatkan

dopamin ekstra sel, nikotin juga menyebabkan pelepasan opioid

endogen dan glukokortikoid..

There is evidence for tolerance to the subjective effects of nicotine.

Smokers typically report that the first cigarette of the day after a night of

abstinence gives the "best" feeling.


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OPIOID

MORPHINHEROIN

METHADONE


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Opioids

Opioid drugs are used primarily for the treatment of pain Some of the CNS

mechanisms that reduce the perception of pain also produce a state of well-

being or euphoria. Thus opioid drugs also are taken outside medicalchannels for the purpose of obtaining the effects on mood.

the standard medications for severe pain remain the derivatives of the opium

poppy (opiates) and synthetic drugs that activate the same receptors

(opioids). for acute pain and for severe chronic pain, the opioid drugs are

most effective. The subjective effects of opioid drugs are useful in the

management of acute pain. This is particularly true in high-anxiety situations,such as the crushing chest pain of myocardial infarction, when the relaxing,

anxiolytic effects complement the analgesia. Normal volunteers with no pain

given opioids in the laboratory may report the effects as unpleasant because

of side effects such as nausea, vomiting, and sedation. Patients with pain

rarely develop abuse or addiction problems. Of course, patients receiving

opioids over time develop tolerance routinely, and if the medication isstopped abruptly, they will show the signs of an opioid-withdrawal syndrome,

the evidence for physical dependence.


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Heroin is the most important opiate that is abused. There is no legal supply of

heroin for clinical use in the United States. Despite claims that heroin hasunique analgesic properties for the treatment of severe pain, double-blind trials

have found it to be no more effective than hydromorphone

Previously, street heroin in the United States was highly diluted: Each 100-mg

bag of powder had only about 4 mg heroin (range 0 to 8 mg), and the rest was

filler such as quinine. In the mid-1990s, street heroin reached 45% to 75%purity in many large cities, with some samples testing as high as 90%. This

means that the level of physical dependence among heroin addicts is relatively

high and that users who interrupt regular dosing will develop more severe

withdrawal symptoms.

Whereas heroin previously required intravenous injection, the more potent

supplies can be smoked or administered nasally (snorted), thus making the

initiation of heroin use accessible to people who would not insert a needle into

their veins.


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STIMULANT

COCAIN

AMPHETAMINECTACY


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Cocaine.. The number of frequent users (at least weekly) has remained

steady since 1991 at about 640,000. Not all users become addicts. A key

factor is the widespread availability of relatively inexpensive cocaine in the

alkaloidal form (free base, "crack") suitable for smoking and the

hydrochloride powder form suitable for nasal or intravenous use..

The reinforcing effects of cocaine and cocaine analogs correlate best with

their effectiveness in blocking the transporter that recovers dopamine from

the synapse. This leads to increased dopamine concentrations at critical

brain sites (However, cocaine also blocks both norepinephrine (NE) and

serotonin (5-HT) reuptake, and chronic use of cocaine produces changes inthese neurotransmitter systems, as measured by reductions in the

neurotransmitter metabolites 3-methoxy-4 hydroxyphenethyleneglycol

(MOPEG or MHPG) and 5-hydroxyindoleacetic acid (5-HIAA).

Cocaine produces a dose-dependent increase in heart rate and blood

pressure accompanied by increased arousal, improved performance on

tasks of vigilance and alertness, and a sense of self-confidence and well-

being. Higher doses produce euphoria, which has a brief duration and often

is followed by a desire for more drug. Involuntary motor activity, stereotyped

behavior, and paranoia may occur after repeated doses. Irritability and

increased risk of violence are found among heavy chronic users.


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Amphetamine and Related Agents.

amphetamine, dextroamphetam ine, methamph etam ine, phenmetrazine,

methy lphenidate, and diethy lpropion.

Amphetamines increase synaptic dopamine primarily by stimulating

presynaptic release

Intravenous or smoked methamphetamine produces an

abuse/dependence syndrome similar to that of cocaine, although clinical

deterioration may progress more rapidly. In animal studies,

methamphetamine in doses comparable with those used by human

abusers produces neurotoxic effects in dopamine and serotonin neurons.

Methamphetamine, a widely available nonprescription stimulant. Oralstimulants, such as those prescribed in a weight-reduction program, have

short-term efficacy because of tolerance development. Only a small

proportion of patients introduced to these appetite suppressants

subsequently exhibits dose escalation or drug seeking from various

physicians; such patients may meet diagnostic criteria for abuse or

addiction.Fenf luramineand pheny lpropanolamine, manzidol reduce appetite with

no evidence of significant abuse potential..

Khatis a plant material widely chewed in East Africa and Yemen for its

stimulant properties; these are due to the alkaloidal cath inone, a

compound similar to amphetamine


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MDMA ("Ecstasy") and MDA.

MDMA and MDA are phenylethylamines that have stimulant as well as

psychedelic effects. MDMA became popular during the 1980s on college

campuses because of testimonials that it enhances insight and self-knowledge.

It was recommended by some psychotherapists as an aid to the process of

therapy, although no controlled data exist to support this contention. Acute

effects are dose-dependent and include feelings of energy, altered sense of

time, and pleasant sensory experiences with enhanced perception. Negative

effects include tachycardia, dry mouth, jaw clenching, and muscle aches. At

higher doses, visual hallucinations, agitation, hyperthermia, and panic attackshave been reported. A typical oral dose is one or two 100-mg tablets and lasts 3

to 6 hours, although dosage and potency of street samples are variable

(approximately 100 mg per tablet).

MDA and MDMA produce degeneration of serotonergic nerve cells and

axons in rats. While nerve degeneration has not been demonstrated inhuman beings, the cerebrospinal fluid of chronic MDMA users has been

found to have low levels of serotonin metabolites Thus, there is possible

neurotoxicity with no evidence that the claimed benefits of MDMA actually

occur.


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Caffeine.

Caffeine, a mild stimulant, is the most widely used psychoactive drug in the

world. It is present in soft drinks, coffee, tea, cocoa, chocolate, and numerous

prescription and over-the-counter drugs.

It mildly increases norepinephrine and dopamine release and enhances neural

activity in numerous brain areas. Caffeine is absorbed from the digestive tract

and is distributed rapidly throughout all tissues and easily crosses the placental

barrier Many of caffeine's effects are believed to occur by means of competitive

antagonism at adenosine receptors. Adenosine is a neuromodulator that

influences a number of functions in the CNS The mild sedating effects that occur

when adenosine activates particular adenosine-receptor subtypes can beantagonized by caffeine.

Tolerance occurs rapidly to the stimulating effects of caffeine. Thus a mild

withdrawal syndrome has been produced in controlled studies by abrupt

cessation of as little as one to two cups of coffee per day.

Caffeine withdrawal consists of feelings of fatigue and sedation. With higherdoses, headaches and nausea have been reported during withdrawal; vomiting

is rare

Although a withdrawal syndrome can be demonstrated, few caffeine users

report loss of control of caffeine intake or significant difficulty in reducing

or stopping caffeine, if desired Thus, caffeine is not listed in the category

of addicting stimulants


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MARIHUANA

GANJA


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Cannabinoids (Marijuana)

The cannabis plant has been cultivated for centuries both for the production of

hemp fiber and for its presumed medicinal and psychoactive properties. The

smoke from burning cannabis contains many chemicals, including 61 different

cannabinoids that have been identified. One of these, D-9-tetrahydrocannabinol

(D-9-THC), produces most of the characteristic pharmacological effects of

smoked marijuana.

Surveys have shown that marijuana is the most commonly used illegal drug inthe United States. Usage peaked during the late 1970s, when about 60% of

high school seniors reported having used marijuana, and nearly 11% reported

daily use.

This declined steadily among high school seniors to about 40% reporting some

use during their lifetime and 2% reporting daily use in the mid-1990s, followedby a gradual increase to 48% of 12th graders in 2002 reporting some use.

Surveys among high school seniors tend to underestimate drug use because

school dropouts are not surveyed.

I t i ti ith ij d h i d ti d


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Intoxication with marijuana produces changes in mood, perception, and

motivation, but the effect sought after by most users is the "high" and

"mellowing out." This effect is described as different from the stimulant high

and the opiate high. The effects vary with dose, but the typical marijuana

smoker experiences a high that lasts about 2 hours. During this time, there

is impairment of cognitive functions, perception, reaction time, learning, andmemory. Impairments of coordination and tracking behavior have been

reported to persist for several hours beyond the perception of the high.

These impairments have obvious implications for the operation of a motor

vehicle and performance in the workplace or at school.

Marijuana also produces complex behavioral changes such as giddinessand increased hunger. There are unsubstantiated claims of increased

pleasure from sex and increased insight during a marijuana high.

Unpleasant reactions such as panic or hallucinations and even acute

psychosis may occur; several surveys indicate that 50% to 60% of

marijuana users have reported at least one anxiety experience. These

reactions are seen commonly with higher doses and with oral ingestionrather than smoked marijuana because smoking permits the regulation of

dose according to the effects. While there is no convincing evidence that

marijuana can produce a lasting schizophrenia-like syndrome, there are

numerous clinical reports that marijuana use can precipitate a recurrence in

people with a history of schizophrenia.


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LSD = LYSERGIC ACID DIETHYLAMIDE

LSD


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LSD

A "bad trip" usually consists of severe anxiety, although at times it is marked by

intense depression and suicidal thoughts. Visual disturbances usually are

prominent. The bad trip from LSD may be difficult to distinguish from reactions

to anticholinergic drugs and phencyclidine. There are no documented toxic

fatalities from LSD use, but fatal accidents and suicides have occurred during

or shortly after intoxication. Prolonged psychotic reactions lasting 2 days or

more may occur after the ingestion of a hallucinogen. Schizophrenic episodes

may be precipitated in susceptible individuals, and there is some evidence that

chronic use of these drugs is associated with the development of persistent

psychotic disorders

A "bad trip" usually consists of severe anxiety, although at times it is marked

by intense depression and suicidal thoughts. Visual disturbances usually are

prominent. The bad trip from LSD may be difficult to distinguish from

reactions to anticholinergic drugs and phencyclidine. There are no

documented toxic fatalities from LSD use, but fatal accidents and suicideshave occurred during or shortly after intoxication. Prolonged psychotic

reactions lasting 2 days or more may occur after the ingestion of a

hallucinogen. Schizophrenic episodes may be precipitated in susceptible

individuals, and there is some evidence that chronic use of these drugs is

associated with the development of persistent psychotic disorders


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Phencyclidine (Pcp).

PCP deserves special mention because of its widespread availability and

because its pharmacological effects are different from those of the psychedelics

such as LSD.PCP was developed originally as an anesthetic in the 1950s and later was

abandoned because of a high frequency of postoperative delirium with

hallucinations.

PCP became a drug of abuse in the 1970s, first in an oral form and then in a

smoked version enabling a better regulation of the dose.

As little as 50 mg/kg produces emotional withdrawal, concrete thinking, andbizarre responses to projective testing. Catatonic posturing also is produced and

resembles that of schizophrenia.

Abusers taking higher doses may appear to be reacting to hallucinations and

exhibit hostile or assaultive behavior.

Anesthetic effects increase with dosage; stupor or coma may occur with

muscular rigidity, rhabdomyolysis, and hyperthermia.Intoxicated patients in the emergency room may progress from aggressive

behavior to coma, with elevated blood pressure and enlarged nonreactive

pupils.


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Inhalants

Abused inhalants consist of many different categories of chemicals that are

volatile at room temperature and produce abrupt changes in mental statewhen inhaled. Examples include toluene (from model airplane glue),

kerosene, gasoline, carbon tetrachloride, amyl nitrite, and nitrous

oxide).

There are characteristic patterns of response for each substance. Solvents

such as toluene typically are used by children. The material usually is placed

in a plastic bag and the vapors inhaled. After several minutes of inhalation,dizziness and intoxication occur.

Aerosol sprays containing fluorocarbon propellants are another source of

solvent intoxication. Prolonged exposure or daily use may result in damage

to several organ systems.

Clinical problems include cardiac arrhythmias, bone marrow depression,

cerebral degeneration, and damage to liver, kidney, and peripheral nerves.Death occasionally has been attributed to inhalant abuse, probably via the

mechanism of cardiac arrhythmias, especially accompanying exercise or

upper airway obstruction.

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Subtance Abused