By Z. Hamid. Anna Maria College. 2019.

This term has been used throughout this book rather than Drug abuse or Drug misuse buy cheap finpecia 1mg, as it is non-judgemental cheap 1mg finpecia otc. Gateway drug An Illicit or Licit drug, use of which is regarded as opening the way to the use of another drug, usually one that is viewed as more problematic. Harmful use A pattern of Psychoactive Substance use that is causing damage to health. The damage may be physical (eg hepatitis following injection of drugs) or mental (eg depressive episodes secondary to heroin use). Harmful use commonly, but not invariably, has adverse social consequences but social consequences are not necessary to justify a diagnosis of harmful use. Harm reduction In the context of alcohol or other drugs, harm reduction describes policies or programmes that focus directly on reducing the harm resulting from the use of alcohol or other drugs. The term is used particularly of policies or programmes that aim to reduce the harm without necessarily affecting the underlying Drug use; examples include Maintenance treatment in Opioid Dependence and needle/syringe exchanges to counteract needle sharing among heroin users. Harm reduction can be used either to refer to goals (focusing on the harm rather than on use per se) or to means (eg needle exchanges, Opioid Substitution Therapy etc); in the latter sense, it is often contrasted to the dichotomy of supply reduction and demand reduction. Hazardous use A pattern of substance use that increases the risk of harmful consequences for the user. Some would limit the consequences to physical and mental health (as in Harmful use); some would also include social consequences. In contrast to Harmful use, hazardous use refers to patterns of use that are of public health significance, despite the absence of any current disorder in the individual user. It is also commonly used for Licit drugs, such as alcohol, which allows comparison between the pattern of use of these drugs and the harm related to their use. These substances cause dopamine to be released rapidly and in huge quantities when compared to usual brain levels, which leads to the intense feelings of pleasure. Illicit drug A Psychoactive substance, the possession, production, sale or use of which is prohibited. Strictly speaking, it is not the Drug that is illicit, but its possession, production, sale or use in particular circumstances in a given jurisdiction. Illicit drug market, a more exact term, refers to the production, distribution, and sale of any drug outside legally sanctioned channels. Complications may include trauma, inhalation of vomitus, delirium, coma, and convulsions, depending on the substance and method of administration. Keyworking A system of providing individualised care though a specific keyworker, who provides a consistent means of contact with medical and social care. It is used for Rehabilitation of Dependence on Illicit drugs and enables support to be tailored to individual need by creating a strong partnership between the individual requiring rehabilitation and the keyworker. Legalisation Legalisation is a process of repealing a prohibition (in criminal law) on a given behaviour or product – in this context, supply, possession or use of an Illicit drug. The process is often coupled with a governmental effort to control or influence the market for the affected behaviour or product. The term should be distinguished from Decriminalisation, which refers to a reduction in the seriousness of an offence or of the penalties it attracts, and specifically the move from a criminal sanction to a civil or administrative one. Licit drug A drug that is legally available, either to purchase, or by medical prescription. Examples of licit Psychoactive drugs that are available to purchase are alcohol and tobacco. It is most commonly used for Opioid Dependence (eg treatment with methadone or buprenorphine – commonly called Opioid Substitution treatment). The aim is to attenuate withdrawal symptoms, diminish opioid Craving and arrive at a Tolerance threshold, while preventing euphoria and sedation from overmedication. Mutual-help movement Voluntary associations, usually led by former drug users who now use their experiences to help others cease drug use and improve their coping skills. Participants support each other in recovering from, or maintaining recovery from, their dependence. It uses a 12-step programme based on a non-denominational spiritual approach, with an emphasis on mutual aid and support. Opiate An opiate is an Addictive drug, derived from the opium poppy, which reduces pain, induces sleep and may alter mood or behaviour (see Opioids). Opioid A generic term applied to alkaloids from the opium poppy (Opiates), their synthetic analogues and compounds synthesised in the body that interact with specific Receptors in the brain and reduce pain, induce sleep and may alter mood or behaviour. Opium alkaloids and their semi-synthetic analogues include morphine, diacetylmorphine (diamorphine, heroin), hydromorphine, codeine and oxycodone. Synthetic opioids include buprenoprhine, methadone, pethidine, pentazocine and tramadol. In absolute numbers, overdoses of Licit drugs are usually more common than those of Illicit drugs.

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The Home Office noted in its submission to the Home Affairs Select Committee in 2001: ‘some people would seem to be attracted to experiment with controlled drugs because of their illegality (eg “forbidden fruits”)’ discount finpecia 1mg without prescription. It is argued that illegality can help young people in particular to ‘say no to drugs’: this is a credible proposition but it is hard to measure its efficacy with any accuracy discount finpecia 1mg line. It is unclear whether comparable prevention efforts are more effective with illegal drugs than legal ones, ie whether the illegality itself is a key aspect of prevention effectiveness (see Chapter 7). In addition to legal sanctions, it is also important to consider the extent to which social, cultural and religious norms may condition and deter use. Writing in the journal Science, Jarvik suggests that religious convictions may account for the lower use of legal substances such as alcohol and tobacco in Amish and Mormon communities. In an illegal market, it is difficult to establish reliable methods to measure availability. While these measures can indicate enforcement successes, they are not measures of availability. Drugs of dependence have more complex economics than other products: drug use does not necessarily follow predictable economic patterns in a simple linear way, which makes generalised conclusions problematic. Levels of use can rise and fall independently of price24 and there is some disagreement between commentators on the impact of price rises. Drawing on the work of Grossman25, Babor and colleagues maintain that even users who are drug dependent cut back on their consumption when prices rise. Enforcement can certainly create obstacles in terms of additional expense and inconvenience, and drug markets can be locally displaced and temporarily disrupted. There is no evidence from the experience of past decades to suggest they can be eliminated or significantly reduced in the long term while demand remains high. Inference from prevalence data (see Chapter 2), and survey data on ‘drug offers’, indicate that drugs remain widely available to those who seek them. In a market that is primarily demand driven and supplied by profit-seeking entrepreneurs, prices are unlikely to rise to a level where demand dries up. Even if supply-side enforcement can successfully achieve a ‘drought’ or push prices for a particular drug beyond the reach of most consumers, the effect is likely to be displacement to other more affordable drugs, or a drop in drug purity as a way of maintaining more consistent street prices. For dependent users on lower incomes, demand may also be less price elastic (for an explanation of price elasticity, see Section 4. The key costs, or unintended consequences, of the prohibition approach are outlined next. These include the risks of overdose, poisoning (from adulterants, bulking agents and other contaminants), and infection from biological contaminants among drug users who inject. The shortage was most marked in New South Wales, which witnessed increases in price, decreases in purity at street level, and reductions in the ease of obtaining the drug. A growing illegal trade is associated with high levels of violence,40 corruption and money laundering. While estimates are hard to formulate,43 volumes of such offending are substantial (see Section 3. The specific role of illegality is underlined by an absence of evidence for acquisitive crime associated with dependent use of alcohol,45,46 tobacco47 or prescription drugs, which are all available legally. Research examining drug d Issues to consider include the influence of intoxication, and links to common exogenous variables such as social deprivation. Very few relayed stories about receiving help from the police: for most of the sample, contact was a negative experience involving routine ‘stopping, checking, questioning, and moving persons on’. When conducted in a busy, public place, some of the sample also felt that police actions were intended to shame the user by exposing their drug use to others. The illicit drug trade has deleterious effects on development and security in many of the world’s most fragile regions and states. This ensures that the threat from enforcement can be kept to a minimum, public officials are relatively easily corrupted, and a ready supply of labour is available from impoverished populations. The endemic violence and corruption that accompany large-scale illicit drug operations massively increases the challenges involved in bringing development to regions involved in drug production, such as Latin and Central America and Afghanistan,62 or those involved in transit, such as the Caribbean and West Africa. When these costs are included, the total criminal justice expenditure is estimated at between £2 billion64 and £4 billion65 per annum. These criminal justice costs are in addition to the wider social and economic costs of drug-related crime itself (see Section 6. It can, for example, make access to vulnerable populations more difficult and make problematic drug users reluctant either to come forward or to disclose information about their drug use (see Section 8. The case in favour of maintaining the overarching prohibitionist status quo has also been put by a range of individuals and agencies. It is additionally argued that the potential for increased use would be made worse by the removal of the deterrent effect of criminality and the ‘wrong message’ that any such reforms would send out, particularly to young people. The point is made that a modified and reformed system could be substantially more effective than the status quo. The point is also made that the options for reform are not binary: criminalisation or non-criminalisation. There is a spectrum of alternatives and permutations of alternatives that could be used to potentially improve upon the present system.

Recent advances in biological and chemical sciences have led to the development of various “Smart” technologies to ensure more effective drug delivery and targeting of drugs to specific sites within the body quality 1mg finpecia. The advantages and limitations of these systems are discussed in detail in Chapter 16 finpecia 1 mg. Such systems are used to achieve site-specific drug delivery following parenteral administration. Release of the attached drug molecules at the target site can be achieved by enzymatic or hydrolytic cleavage. Larger complexes, some undergoing clinical trials, include drug conjugates with soluble natural, or synthetic, polymers. Nano- and microparticles Nanoparticles are solid colloidal particles, generally less than 200 nm. Such systems include poly (alky1- cyanoacrylate) nanoparticles used for parenteral drug delivery and targeting. Microparticles are colloidal particles in the micrometer scale, typically in the size range 0. Synthetic polymers, such as poly(lactide-co-glycolide), are widely used in the preparation of microparticulate drug delivery systems and also as biodegradable implantable devices. Natural polymers, such as albumin, gelatin and starch, are also used as microparticulate drug carriers. Liposomes, vesicular structures based on one or more lipid bilayer(s) encapsulating an aqueous core, represent highly versatile carriers. Liposomes can be prepared using a variety of techniques to give a wide range of sizes (approximately 30 nm–10 µm), structures and physicochemical properties, to facilitate the encapsulation of both water-soluble and lipid-soluble drugs (see Section 5. Commercial products based on liposome technology are available and many more products are in clinical trials, for a variety of indications. Macrodevices Macrodevices are widely used in many applications, including: • parenteral drug delivery, mechanical pumps, implantable devices; • oral drug delivery: solid dosage forms such as tablets and capsules which incorporate controlled release/ targeting technologies; • buccal drug delivery: buccal adhesive patches and films; • transdermal drug delivery: transdermal patches, iontophoretic devices; • nasal drug delivery: nasal sprays and drops; • pulmonary drug delivery: metered-dose inhalers, dry-powder inhalers, nebulizers; • vaginal drug delivery: vaginal rings, creams, sponges; • ophthalmic drug delivery: ophthalmic drops and sprays. This is painful for the patient, as well as generally requiring the intervention of medical professionals. The oral route, which involves merely swallowing a tablet, liquid or capsule, thus represents a much more convenient and attractive route for drug delivery. Some other dosage forms, for example nebulizers, pessaries and suppositories, may meet with more limited patient compliance. Ease of termination The dosage form should be easily removed either at the end of an application period, or in the case where continued drug delivery is contra-indicated. A transdermal adhesive system is easily removed if necessary, as is a buccal patch. However, non-biodegradable polymeric implants and osmotic pumps must be surgically retrieved at the end of treatment. Although a biodegradable polymeric implant does not require surgical retrieval, its continuing biodegradation makes it difficult to terminate drug delivery, or to maintain the correct dose at the end of its lifetime. Biocompatibility and absence of adverse effects The drug delivery system should be non-toxic and non-immunogenic. For example, concerns over the body’s responses to a foreign material often raise the issues of biocompatibility and safety of implantable devices. The use of dosage forms containing penetration enhancers, which potentiate drug absorption via a variety of mechanisms and are used in oral, buccal, transdermal, nasal, ophthalmic, pulmonary and vaginal drug delivery, has raised serious questions about the potential deleterious effects they exert on epithelial tissue. As well as the possibility of direct damage to the epithelium, the increased epithelial permeability may allow the ingress of potentially toxic agents. Large effective area of contact For drugs absorbed via passive mechanisms (see Section 1. The dosage form can influence the size of the area over which the drug is deposited. For example, the use of nasal drops offers a larger solution/ membrane surface area for immediate absorption than if the drug solution is delivered in the form of a nasal spray (see Section 9. Prolonged contact time Drug delivery to epithelial sites is often limited by a variety of physiological clearance mechanisms at the site of administration. Ideally, the dosage form should facilitate a prolonged contact time between the drug and the absorbing surface, thereby facilitating absorption. Bioadhesive materials (sometimes also termed mucocadhesive) adhere to biological substrates such as mucus or tissue and are often included in dosage forms in order to increase the effective contact time. Although the oral route is the preferred route of 64 administration, many drugs are unsuitable for oral delivery and must be given parenterally. However, alternative routes (in particular the transdermal and pulmonary routes) are assuming greater importance as alternative non-injectable routes of systemic delivery. In order to maximize the amount of drug entering the systemic circulation from the site of administration, the delivery site should possess certain properties, as discussed below. No single route matches all the physiological requirements of an “ideal” absorption site; the relative extent to whether these criteria can be fulfilled for each particular route are summarized in Table 3. For example, due to the presence of the Folds of Kerckring, the villi and the microvilli, the available surface area of the small intestine of the gastrointestinal tract is very large, making this region an extremely important one for oral drug delivery. The surface area of the lungs, which has evolved physiologically for the highly efficient exchange of gases, is also very extensive, making this region a promising alternative route to the parenteral and oral routes for systemic drug delivery.

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