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ADDICTION


AS PHARMACIStS, YoU ARE fRont-lInE HEAltHCARE PRoVIDERS, AnD ARgUABlY tHE MoSt ACCESSIBlE of All HEAltH CARE PRofESSIonAlS. AS SUCH YoU ARE BESt PoSItIonED to HElP PREVEnt AnD tREAt SUBStAnCE USE DISoRDERS…


ADDICtIon D


By Kurtis Moffatt


rug abuse and addiction are an ever-growing issue in not only terms of their incidence,


but also complexity. no longer can we think in terms of a person being addicted to one drug or another, however it is more commonly seen that an individual uses many different drugs in combination.


the issue is complicated further by the co-occurrence of substance abuse and mental illness. Even specialists find it difficult to differentiate the cause and effect when the two conditions co-exist within the same person. It is clear however that these are synergistic pathologies each exacerbating the symptoms of the other.


the pharmacy profession has evolved in recent years, with pharmacists becoming more heavily involved in newer practices, such as assistance with the clinical management of opioid and other drug dependencies.


Pharmacists consequently need to be well informed in order to deliver these services. Accordingly, we need to be educated about issues related to addiction, and prepared to not only


32 - PHARMACY In foCUS


screen, assess, refer, and collaborate with physicians in the care of these patients, but also to be the faces of change in community in combating drug abuse.


numerous risk factors for addiction have been identified. genetic predisposition is commonly regarded as a strong predictor for eventual disease. thus, while the general population risk for alcoholism stands at thirteen per cent, the risk is much larger - around 50 per cent for sons whose fathers are or were alcoholic.


Additionally, there is a gender bias, in which males are more at risk than females. of course, the risk of addiction is stronger for some drugs than for others. one measure of addiction potential of certain drugs is demonstrated by the proportion of those who experiment with a drug who eventually become habitual users later.


Using this measure, the most addictive behaviour is cigarette smoking that claims 40-60 per cent of those who try cigarettes, followed by cocaine abuse, as about 30-50 per cent of experimenters become chemically dependent. Heroin addiction occurs in about 25-40 per


AnD tHE PHARMACISt


cent of experimenters. Alcohol addiction occurs in about thirteen to 18 per cent of those who experiment with it, while marijuana addiction occurs in about six-nine per cent of users.


the physical and mental health risks associated with illicit substance abuse increases as addiction and dependence to the drug deepens. (https://harmreductionjournal.biomed central.com/articles/10.1186/1477- 7517-1-3#CR12)


By trying to understand the reasons why people actually use drugs, the help and support that we as pharmacists provide may actually be tailored to that individual.


Psychoactive agents (ie, drugs that have an effect on the brain) can alter a person’s consciousness, mood and thought process. they do so by acting on the brain function and associated receptor pathways, which normally regulate mood, thought and motivation.


Any substance that produces a ‘reward’ when taken can lead the person to repeat its use, which ultimately leads to dependence (the northern Ireland Drug Misuse Database (nIDMD) 2016 statistics, of


all drugs used by patients the most commonly reported drug was cannabis (66 per cent), followed by benzodiazepines (37 per cent) and then cocaine (35per cent)).


Reasons for abuse of these drugs are complex, and include: enjoyment, experimentation, boredom and peer pressure. one of particular concern is self-medication, which warrants further discussion.


If a person suffers from an existing condition they may choose to take a drug to improve their symptoms, for example if a person suffers from pain, they may self medicate with opioid painkillers (over a quarter of those involved in the nIDMD 2016 statistics (26 per cent) used at least one opioid analgesic drug, with 20 per cent of all clients using one as their main drug). If medical advice is not sought, this may lead to dependence.


However, more commonly in this context, self medication refers to when the patient has a pre-existing mental illness and tries to alleviate the symptoms by taking a substance. this can be alcohol, tobacco or illicit drugs. (https://www.health- ni.gov.uk/sites/default/files/publication s/health/dmd-2015-16.pdf)


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