Subtance abused psikotropika dan narkotika

Prof. Moch Aris Widodo PhD PPD UNISMA

PSIKOTROPIKA DEPRESANT STIMULANT ALKOHOL HALUCINOGEN NARCOTIKA MARIHUANA / GANJA

STRESS BROKEN HOME

COBA COBA RECREATIONAL PENGOBATAN DIPAKSA

AKUT KEMATIAN ADAPTASI SEL NEURON KETERGANTUNGAN FISIK PSIKIS

TOLERANCE

KEMATIAN SEL NEURON

ADDICTION

DEGENERASI NEURON

WITHDRAWL SYMPTOM

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 / dependence Withdrawal symptom

drugs
Drug Abuser addict

user

environment

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

CRITERIA FOR DRUG DEPENDENCE/ ADDICTION Primary criteia highly controled or compulsive use psychoactive effect drug reinforced behavioor Additional criteria addictive behavior often involves stereotypical pattern of use used depite harmful effects relaps following abstinence recurrent drug cravings Dependence producing drug often produce tolerance physical dependence pleasant euphorian effects

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 reinforcment suatu 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 nicotine semuanya menyebabkan peningkatan kadar dopamine pada ventral striatum terutama pada daerah nucleus nucleus accumbens

HOST USER

TERDAPAT VARIASI RESPON PENGGUNA OBAT OBAT PSIKOTROPIKA DAN NARKOTIKA

RESPON BERBEDA WALAU DOSIS YANG DIGUNAKAN SAMA HAL INI OLEH KARENA KADAR OBAT DALAM PLASMA BERBEDA ADA POLIMORPHISME DARI GEN YANG MENGKODE ENZIM YANG TERLIBAT DALAM ABSORBSI,METABOLISM DAN EKRESI RESPON AKIBAT IKATAN OBAT DENGAN RESEPTOR TOLERANCE PENGALAMAN PENGGUNAAN YANG MENYENAGKAN PADA PERISTIWA TERTENTU SPRTIMEROKOK SETELAH MAKAN

Environmental Variables. 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.

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.,

TOLERANCE UNTUK MENDAPATKAN EFEK YANG SAMA DIBUTUHKAN DOSI YANG LEBIH BESAR INNATE TOLERANCE TOLERANCE YANG SECARA GENETIK DITURUNKAN ACQUIRED TOLERANCE PARMAKOKINETIK : TOLERANCE OK PERUBAHAN ABSORBSI, METABOLISM, DAN EKSKRESI OBAT PHARMACODYNAMIC : TOLERNCE YANG TERJADI OLEH KARENA 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 LAIN ACUTE TOLRANCE : TOLERANCE YANG TERJADI SANGAT SINGKAT, DALAM BEBERAPA JAM PENGGUNAAN

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 obat tersebut .
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

Adiksi terhadap suatu obat

neuroadaptation

Peggunaan terhenti Proses maladaptive

Timbul gejala withdrawal Gejala sebaliknya dari efek obat Narcotika Agitasi, eksitasi, alkohol Dehidrasi, nyeri hebat narkotik

kematian

Penyalahgunaan obat tergantung pada kecepatan peningkatan kadar obat Di otak misalnya COCAINE Penduduk pegunungan andes di amerika selatan, menguyah daun coca untukmendapatkan efek meningkatkan stamina namun jarang terjadi penyalah gunaan dan ketergantungan oleh karena mengunyah daun koka penyerapan 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 DENGAN MEGHIRUP UAPNYA (SETELAH DICAMPUR AIR PANAS ) SAMA CARA PEMAKAIANNYA DENGAN NICOTIN DAN MARHUANA

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

OBAT YANG MENDEPRESI CNS

Ethanol. More than 90% of American adults report experience with ethanol (commonly called alcohol), and approximately 70% report some level of current use. The lifetime 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

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.

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.

OPIOID MORPHIN HEROIN METHADONE

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 wellbeing or euphoria. Thus opioid drugs also are taken outside medical channels 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 is stopped abruptly, they will show the signs of an opioid-withdrawal syndrome, the evidence for physical dependence.

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 has unique 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.

STIMULANT COCAIN AMPHETAMIN ECTACY

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 in these 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 wellbeing. 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.

Amphetamine and Related Agents. amphetamine, dextroamphetamine, methamphetamine, phenmetrazine, methylphenidate, and diethylpropion. 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. Oral stimulants, 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. Fenfluramine and phenylpropanolamine , manzidol reduce appetite with no evidence of significant abuse potential.. Khat is a plant material widely chewed in East Africa and Yemen for its stimulant properties; these are due to the alkaloidal cathinone, a compound similar to amphetamine

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 attacks have 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 in human 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.

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 be antagonized 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 higher doses, 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

MARIHUANA GANJA

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 in the 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, followed by 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.

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, and memory. 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 giddiness and 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 ingestion rather 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.

LSD = LYSERGIC ACID DIETHYLAMIDE

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 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

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, and bizarre 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.

Inhalants Abused inhalants consist of many different categories of chemicals that are volatile at room temperature and produce abrupt changes in mental state when 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.