Intraveneous Drug Abuse

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Sarah Boone & Jeremy Randolph from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Jeremy Randolph, Sarah Boone, Lucinda hampton, Kim Jackson, Elaine Lonnemann, WikiSysop, Wendy Walker, Adam Vallely Farrell and Vidya Acharya  

Definition/Description

Intraveneous (IV) drug use is the injection of chemicals into the body via a hypodermic needle into a vein.  Drugs can also be injected under the skin (also called "skin popping" or directly into the muscle (intramuscular injection).  Heroin is the illegal drug that is most commonly administered by intravenous injection but other drugs such as amphetamines, methamphetamines, and cocaine can be administered by IV injection. (http://emedicine.medscape.com/article/286976-overview as cite)

The DSM V defines substance abuse as:

1. Using a substance longer than intended

2. Desire for or unsuccessful efforts to reduce or cease use of the substance

3.  Large amount of time trying to obtain, use, or recover from a substance

4. The use of the substance results in a failure to fufil life obligations

5.  Use continues despite causing social disturbances (family, job, etc...)

6.  Tolerance

7. Withdraw.

Prevalence

A 2007 study showed that from 1979-2002 the overall all prevalence of IV drug abuse was 1.5%.  The prevalence was highest in 35-49 year old age group with a rate 3.1%.  IV drug use was higher in males(prevalence of 2.0%) than females(1.0%).  It was also higher in caucasians (1.7%) than African Americans (0.8%) or Hispanics (1.1%).  The study also showed that only 0.19% of subjects reported using IV drugs in the past year.  (cite http://www.ncbi.nlm.nih.gov/pubmed/17242318)

Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

Medications used to treat heroin abuse are as follows:

• Methadone- Methadone is a slow acting opioid agonist.  Although it effects opioid receptors it does not produce a pronounced "high."  Methadone also prevents symptoms of withdraw.
  
• Buprenorphine- A partial opioid agonist.  Buprenorphrine relieves cravings without producing a "high" or other dangerous side effects.  Buprenorphine also includes naloxone.
  
• Naloxone- An opioid antagonist.  It blocks opiod action and is not sedating and does not cause dependence. (cite heroin emial)
  

No medications have been approved for methamphetamine abuse but the following are under study:

• Paxil- an antidepressant that contains ondanestron, which has been shown to reduce cravings and withdraw.
  
• Bupropion (Wellbutrin)- an antidepressant was shown to reduce meth abuse in low to moderate users and reduce cravings.
  
• Modafinil- A central nervous system stimulant that may help with meth withdraw symptoms andimprove cognition.
  
• Mirtazapine (Remeron)- an antidepressant that has been shown to decrease meth use. (cite http://www.addictionrecoveryguide.org/medication/methamphetamine)
  

There are several medications under study for the treatment of cocain abuse and withdraw:

• Baclofen-  A muscle relaxer that has been shown to reduce the amount of dopamine released by cocaine use. 
  
• Tiagabine- A seizure medication which was shown to be moderately effective for improving abstinence in cocaine and opiate users.
  
• Disulfiram-  A medication used alcoholism that makes the side effects of alcohol very unpleasant has also been shown to increase anxiety in cocaine users to intolerable levels. (cite http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994240/)
  

Diagnostic Tests/Lab Tests/Lab Values

Addiction or abuse of a drug cannot be determined by a lab test, but use of the drug can be determined by testing of biological specimens from a subject.  Blood, urine, hair, saliva can all be used to determine whether a drug or metabolites of the drug are present.  A urinalysis is the most commonly used way to determine drug use in sports and the work place. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) sets the guidelines for drug testing for federal agnecies and requires testing for:

• Amphetamines (including methamphetamines, ecstasy)
• THC
  
• Cocaine
• Opiates (heroin, opium, codeine, morphine)
• Phencyclidine (PCP)
  

Many employers commonly use an eight panel test which often includes the previously listed substances and the following:

• Barbiturates
  
• Benzodiazepines (tranquilizers like Valium and Xanax)
• Methaqualone (Quaaludes)
  

(Cite http://www.dol.gov/elaws/asp/drugfree/drugs/dt.asp)

Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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