Drug Abuse - Drugs in Beverages and Tobacco

Any drug when used for a non-medical purpose, is said to be misused or abused. During the last few decades, drug abuse has become a serious problem for the individual and the society. Besides adversely affecting the well being, progress, and the health of the user, it leads to a tragic family life. Amongst those who handle drugs, that is, the doctor, the nurse the pharmacist, and the patient, the maximum responsibility for the proper distribution of drugs is that of the pharmacist. Under the laws of India drugs which can be abused are dispensed by the pharmacist only under a doctor's prescription and are controlled by the legal provisions of the Drugs and Cosmetics Act. Non-compliance of this Act by the pharmacist can promote misuse of drugs and bring misery to the user.

To understand the phenomenon of drug abuse it is important to know a few terms which are commonly used in this context and the classification of drugs of abuse.

Drug Dependence or Addiction: This is a biological phenomenon and includes both psychic and physical dependence. Psychic dependence is seen in the form of compulsive and repeated drug-taking for personal satisfaction. Heavy cigarette smoking is an example. Physical dependence which is present when withdrawal of a drug produces symptoms that are opposIte to those sought by the user, Alcohol withdrawal syndrome is a common example.

The patterns of addiction development and types of behavioural symptoms of drug dependence not only vary from drug to drug but are also influenced by the socio -cultural background of the individual. It is, therefore, difficult to prescribe anyone uniform treatment or various forms of drug abuse.

Drug Tolerance: It after repeated use of a drug, a larger dose is needed to produce the same effect, a state of tolerance is said to have developed for that drug, Tolerance is closely associated with the phenomenon of physical dependence and in almost all cases, the person needs a larger successive dose of the drug for the same effect. For example, persons who are dependent on morphine may, at times, need 200 times the usual dose for its euphoric effects.

Drugs as Reinforcers: A number of psychoactive drugs serve as reinforcers to initiate a self-administration habit, and when such a drug is repeatedly used, it can cause compulsive drug abuse behaviour. In humans, reinforcement is in the form of a feeling of pleasure, relief of pain, discomfort, or an altered perception. Reinforcement behaviour has been extensively studied in rate, monkeys, and baboons and shows certain patterns of self-administration of drugs. In humans, it may act as a reinforcer even in the absence of physical dependence or any preexisting psychopathological conditions.

Drugs in Beverages and Tobacco

Caffeine in tea, coffee, cold drinks: A cup of tea may carry 30 to 45 mg, coffee, 80 to 100 mg; and cola drinks, about 30 mg of caffeine. No serious harm is done even by repeated consumption. Non-availability of these drinks can lead to a mild headache or bodyache.

Ethyl alcohol: If used habitually it may cause dependence or addiction and tolerance, and may thus end up causing physical and economic ruin to the user and misery to the family. If alcohol is taken in high doses, it causes behavioural changes, mental confusion, incoordination, and even coma. Diagnosis of alcohol toxicity can be extremely difficult if a sick or injured person happens to have taken alcohol as well. Alcohol enhances the sedative properties of antihistaminics and of tranquillizers, and thus causes unwanted side-effects. In these situations its use is contraindicated. Ethyl alcohol, if adulterated with or substituted by methyl alcohol, can cause severe poisoning, leading to acidosis, unconsciousness and blindness.

Nicotine: It is taken in a number of forms of tobacco, in bidies, cigarettes, in paan, or as snuff(intranasal administration). While tobacco consumption does not benefit the user, it has been clearly established that it is the cause of many chronic ailments and it can decrease longevity which is evident from the adjacent graph:

Adverse Effects of Smoking: While men smoke more often than women in India, the incidence of women smokers in lower classes is very high. A common ill-effect of smoking is lung cancer. Giving up smoking reduces the risk of premature death, and after 10 years, the risk approximates to that of a lifelong non-smoker. The risk of developing cancer of the mouth and throat is 5-10 times more in smokers than 10 non-smokers. Under the age of 65, smokers are about twice as likely to die of coronary heart disease as are non-smokers, and heavy-smokers, about 3.5 times as likely. The narrowing of the smallest coronary arteries is enormously increased in heavy and even moderate smokers. Other problems faced by smokers are chronic bronchitis and chronic lung disease leading to congestive heart failure. Women who smoke are more likely to be infertile or take longer to conceive than women who do not smoke. They also run the risk spontaneous abortion.

Smoking Cessation Techniques: There are many smokers who wish to quit, but peer pressure and withdrawal effects reinduct them back to smoking. They are often heard saying 'Smoking is easy to quit, I have done it many times'! Proper education, behavioural intervention and some drugs can help in giving up smoking.

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