101: Drug Abuse

Question 1

What is the definition of drug abuse?

Answer 1

Drug abuse is the recurrent use of illegal drugs or the misuse of nonprescription or prescription drugs that results in negative consequences.

Question 2

What are the most commonly used illicit drugs according to the 2015 UNODC report?

Answer 2

1. Cannabis - most widely used drug in the world (excluding caffeine)
2. Amphetamines - second most commonly used drugs
3. Cocaine
4. Prescription opioids - highest negative health impact

Question 3

What are some environmental risk factors associated with drug abuse?

Answer 3

• Easy access to the drug
• Poor school bonding
• Peer use
• Trauma, both physical and psychological
• Parental use
• Family conflict in the home

Question 4

What are the protective factors that can reduce the risk of drug abuse?

Answer 4

• Religiosity
• Strong family support
• Social involvement in community organizations

Question 5

What is the gold standard for diagnosing drug use?

Answer 5

Drug testing is the gold standard for diagnosing most legal and illegal agents, using bodily fluids such as blood, urine, saliva, and hair.

Question 6

What are the clinical features associated with intravenous drug use?

Answer 6

Track marks are a result of venous thrombosis with subsequent scarring and pigmentation of the veins, caused by:
- Repeated injections
- Use of blunt needles
- Irritation from chemicals added to the injected material
Early lesions may show crusting and ecchymosis, while chronic use can lead to linear cords.

Question 7

What is the global prevalence of illicit drug use according to the 2015 UNODC report?

Answer 7

5.2%.

Question 8

Which drug is identified as the most widely used drug in the world?

Answer 8

Cannabis.

Question 9

What is the significance of recognizing signs and symptoms associated with drug use?

Answer 9

It is crucial and potentially lifesaving.

Question 10

What is the impact of prescription pain relievers in drug abuse?

Answer 10

They are the second most commonly used drugs and can lead to significant health impacts.

Question 11

What are the common cutaneous findings associated with drug abuse?

Answer 11

Common findings include dental caries, madarosis, scarring, tattooing, and staining in the skin.

Question 12

What is the significance of twin studies in understanding drug addiction?

Answer 12

Twin studies suggest that at least some component of drug abuse and dependence is driven by genetic preponderance.

Question 13

What are the common sites for intravenous drug use (IDU) and how does scarring relate to drug use duration?

Answer 13

Common sites for IDU include:
- Medial vein in the antecubital fossa of the nondominant arm
- Less visible sites: popliteal fossa, dorsal veins of the feet, inguinal veins
Scarring is associated with longer duration of drug use, and cocaine does not typically induce track marks as it lacks the sclerosing chemicals found in other drugs like heroin.

Question 14

What are the potential complications of skin popping in drug users?

Answer 14

Skin popping can lead to:
- Irreversible tissue injury resulting in irregular, leukodermic, atrophic scars
- Hypertrophic scars or keloids
- Increased risk of infections, particularly skin and soft tissue infections (SSTIs) due to deeper and multilobulated infections compared to IV injections.

Question 15

What are the common pathogens associated with skin and soft tissue infections (SSTIs) in intravenous drug users (IDUs)?

Answer 15

• Staphylococcus species (particularly Staphylococcus aureus): Most frequent
• Group A β-hemolytic Streptococcus: Common
• Eikenella corrodens: Common in IDUs who clean needles with saliva
• Clostridium species (e.g., Clostridium botulinum): Associated with skin popping
• Gram-negative bacteria and anaerobes: Common in anaerobic infections

Question 16

What are the symptoms and treatment options for wound botulism in IDUs?

Answer 16

Symptoms of wound botulism include:
- Blurred vision
- Diplopia
- Ptosis
- Pain, swelling, and tenderness
Treatment options include:
1. Antitoxin
2. High-dose penicillin
3. Surgical debridement

Question 17

What is necrotizing fasciitis and how is it commonly presented in IDUs?

Answer 17

Necrotizing fasciitis is a severe infection that can occur in IDUs, commonly presenting with:
- Severe pain disproportionate to examination findings
- Abnormal temperature (88% of cases)
- Classic findings include hemorrhagic bullae, systemic toxicity, and palpable crepitans.
Surgical exploration is often necessary in cases with unexplained severe pain.

Question 18

What are the cutaneous signs of endocarditis associated with intravenous drug use (IDU)?

Answer 18

Cutaneous signs of endocarditis in IDUs include:
- Janeway lesions
- Osler nodes

Question 19

What is skin popping in the context of drug use?

Answer 19

Injecting drugs intradermally or subcutaneously, often when veins can no longer be found.

Question 20

What are the potential consequences of skin popping?

Answer 20

Irreversible tissue injury leading to irregular, leukodermic, atrophic scars.

Question 21

What is a common complication associated with skin and soft tissue infections (SSTIs) in IDUs?

Answer 21

Sepsis.

Question 22

What are some common pathogens cultured from SSTIs in IDUs?

Answer 22

Staphylococcus species, group A β-hemolytic Streptococcus, and oral pathogens like Eikenella corrodens.

Question 23

What is wound botulism and how is it commonly caused in IDUs?

Answer 23

Wound botulism is most commonly caused by the injection of black tar heroin, which is cut with dirt.

Question 24

What are the classic findings of necrotizing fasciitis in IDUs?

Answer 24

Hemorrhagic bullae, systemic toxicity, and palpable crepitans.

Question 25

What causes hyperpigmentation in drug users?

Answer 25

It can be a result of cooking drugs and flaming needles, leading to carbon and soot deposits in the dermis.

Question 26

What are some independent risk factors for SSTIs in IDUs?

Answer 26

Skin popping, use of nonsterile needles, and the use of speedballs (mixture of heroin and cocaine).

Question 27

What are the common clinical consequences of inhalant abuse?

Answer 27

Inhalant abuse can lead to a wide range of clinical consequences including: - Mucous membrane irritation: rhinorrhea, epistaxis, sneezing, coughing, excess salivation, conjunctival injection, dyspnea, and wheezing. - Dermatologic eruptions in the perioral and/or perinasal distribution. - 'Huffer's rash': perioral or perinasal dermatitis with pyoderma. - Frostbite on the face or oral/nasal cavity from inhalation of refrigerants or coolants. - Yellow crust appearance in hand/face dermatitis caused by nitrites.

Question 28

What are the effects and risks associated with cocaine use?

Answer 28

Cocaine is a sympathomimetic drug that creates feelings of euphoria and can cause: - Tachycardia, altered mental status, hypertension, and mydriasis. - Cutaneous signs include halitosis, frequent lip smacking, cuts and burns on the lips, and midline destructive lesions of the nasal septum from snorting. - Various types of vasculitis, including urticarial vasculitis and Churg-Strauss vasculitis.

Question 29

What is Levamisole and what are its effects when added to cocaine?

Answer 29

Levamisole is a common adulterant added to cocaine that: - Increases bulk and weight, enhancing the euphoric effects of cocaine. - Can cause Levamisole-induced necrosis syndrome (LINES), characterized by distinctive retiform purpura and associated with leukopenia and high titers of specific antibodies.

Question 30

What are the common methods of heroin administration and their associated risks?

Answer 30

Heroin can be administered through various methods: 1. **Injection**: Heated and drawn into a syringe, can be done up to 4 times a day. 2. **Snorting**: Inhaled through the nose. 3. **Smoking**: Inhaled as vapors, often with tobacco. Associated risks include: - Respiratory depression and addiction. - Cutaneous signs such as urticaria and intense itching (high pruritus).

Question 31

What is the primary substance from which heroin is synthesized?

Answer 31

Heroin is synthesized from morphine, which is extracted from the opium poppy plant.

Question 32

What is the primary population that commonly abuses inhalants?

Answer 32

Adolescents are the most common population to abuse inhalants.

Question 33

What are the three groups of common inhalants of abuse?

Answer 33

The three groups are volatile solvents, nitrous oxide, and volatile alkyl nitrites.

Question 34

What are the clinical consequences of inhalant abuse?

Answer 34

Inhalant abuse can lead to mucous membrane irritation, rhinorrhea, epistaxis, sneezing, coughing, excess salivation, conjunctival injection, dyspnea, wheezing, and dermatitic eruptions in the perioral and/or perinasal distribution.

Question 35

What is a common sign of cocaine abuse related to the nasal area?

Answer 35

Midline destructive lesions of the nasal septum can occur from snorting cocaine.

Question 36

What are the side effects associated with levamisole-adulterated cocaine?

Answer 36

Side effects include levamisole-induced necrosis syndrome (LINES), leukopenia, and high titers of antineutrophil antibodies.

Question 37

What are the common cutaneous signs of heroin abuse?

Answer 37

Common cutaneous signs include urticaria, intense itching (high pruritus), and 'puffy hand syndrome' which is edema in the dorsal hands.

Question 38

What is the method of administration for heroin that is most commonly used?

Answer 38

Heroin is most commonly heated, drawn into a syringe or eyedropper through cotton, and then injected.

Question 39

What is a potential complication of cocaine abuse that can be misdiagnosed as Wegener granulomatosis?

Answer 39

Cocaine-induced midline destructive lesions may cause aggressive nasal deformity that can be misdiagnosed as Wegener granulomatosis.

Question 40

What is the significance of 'huffer's rash' in inhalant abuse?

Answer 40

'Huffer's rash' is a perioral or perinasal dermatitis with pyoderma that indicates inhalant abuse, often associated with the use of nitrites.

Question 41

What is the likely cause of retiform purpura on the ears and leukopenia in a cocaine user?

Answer 41

The symptoms are indicative of levamisole-induced necrosis syndrome (LINES), caused by levamisole-adulterated cocaine.

Question 42

Formication is linked to abuse of what drug?

Answer 42

Cocaine abuse.

Question 43

What drug is most likely responsible for delusional parasitosis in a user?

Answer 43

Cocaine.

Question 44

What is the main active ingredient in ecstasy?

Answer 44

The main active ingredient in ecstasy (MDMA) is 3,4-methylenedioxymethamphetamine.

Question 45

What are the potential cutaneous effects associated with methamphetamine?

Answer 45

Signs of methamphetamine abuse include intense pruritus, body odor, weight loss, premature aging, hyperhidrosis, and 'Meth mouth', which involves numerous dental caries and enamel erosions.

Question 46

What are the common methods of consuming cannabis?

Answer 46

Cannabis can be consumed through inhalation, oral ingestion, sublingual use, and topical application.

Question 47

What are cutting agents in drug abuse?

Answer 47

Cutting agents are additional ingredients that can be added to drugs of abuse to increase the volume of the product for additional profit or may be unintentionally included during the manufacturing process.

Question 48

What is the effect of GHB when used as a party drug?

Answer 48

It can induce a reversible coma and short-term memory loss.

Question 49

What is a common dental issue associated with methamphetamine use?

Answer 49

'Meth mouth', characterized by numerous dental caries and enamel erosions.

Question 50

What is the effect of cannabis on appetite?

Answer 50

It can increase appetite, often referred to as 'the munchies'.

Question 51

What are the common cutaneous reactions associated with the use of cannabis?

Answer 51

Acne, allergic reactions, and contact dermatitis.

Question 52

What is the primary psychoactive compound found in marijuana?

Answer 52

Delta-9-tetrahydrocannabinol (THC).

Question 53

What are the potential effects of methamphetamine use?

Answer 53

Euphoria, increased energy, anxiety, aggression, hallucinations, and severe withdrawal.

Question 54

What is a common cutaneous manifestation of MDMA (Ecstasy) use?

Answer 54

Acneiform eruption known as 'ecstasy pimples'.

Question 55

What are the potential complications of chronic cannabis use?

Answer 55

Cannabis arteritis, which can lead to peripheral ischemia and necrosis.

Question 56

What is the primary psychoactive ingredient in betel quid?

Answer 56

Areca nut is the primary psychoactive ingredient in betel quid.

Question 57

What are the adverse effects of using Krokodil?

Answer 57

Krokodil use can lead to widespread necrotizing skin lesions and aggressive necrotic ulcerations.

Question 58

What are common cutaneous manifestations associated with alcohol abuse?

Answer 58

Spider angiomata, palmar erythema, and telangiectasia are common cutaneous signs in alcohol abuse.

Question 59

What are the effects of tobacco use on skin conditions?

Answer 59

Tobacco use can incite or worsen chronic skin conditions, including psoriasis, hidradenitis suppurativa, and subacute and chronic cutaneous lupus erythematosus.

Question 60

What are the hallmark cutaneous conditions associated with alcohol abuse?

Answer 60

The hallmark cutaneous condition associated with alcohol abuse is porphyria cutanea tarda.

Question 61

What are the effects of betel chewing on oral health?

Answer 61

Chewing betel can cause maceration, erosions, and fissures of the oral commissures, and increases the risk of oral carcinoma.

Question 62

What is the effect of tobacco on wound healing?

Answer 62

Tobacco's effects on fibroblasts and the microvasculature impair wound healing.

Question 63

What are the common cutaneous effects of prescription opiates?

Answer 63

Urticaria and pruritus are the most common cutaneous effects of prescription opiates.

Question 64

What is the significance of nicotine in tobacco?

Answer 64

Nicotine is addictive due to its mood-boosting effects and appetite suppression.

Question 65

What are the potential consequences of using talc and starch in drug administration?

Answer 65

Talc and starch can cause foreign-body granulomas after parenteral use with various drugs.

Question 66

What are the skin changes associated with the use of Krokodil?

Answer 66

Users experience thick, scaly, green-black skin changes and widespread necrotizing skin lesions.

Question 67

What are the potential oral health conditions associated with tobacco use?

Answer 67

Conditions include leukokeratosis nicotinica palati, oral verrucous carcinoma, and oral melanosis.

Question 68

What are the common side effects of prescription opiates?

Answer 68

Common side effects include CNS depression, urticaria, and pruritus.

Question 69

What is the significance of the term 'vaping' in relation to tobacco use?

Answer 69

Vaping refers to inhaling tobacco through a vaporizer, which infuses water into the smoke, representing a new method of tobacco consumption.

Question 70

A patient presents with a brownish-red discoloration of the buccal mucosa and irregular desquamation. They admit to chewing a mixture of areca nut and betel leaf. What is the diagnosis?

Answer 70

The patient has 'chewer’s mucosa,' a condition associated with betel quid use.

Question 71

A 50-year-old male smoker presents with pain and necrosis of the digits. What is the likely diagnosis?

Answer 71

The patient likely has thromboangiitis obliterans (Buerger disease), an inflammatory arteritis associated with tobacco use.

Question 72

What are anabolic steroids and how are they commonly used?

Answer 72

Anabolic steroids are synthetic hormones similar to testosterone that can be ingested or injected. They have many legal indications but are often illicitly used to build muscle and enhance athletic performance.

Question 73

What are some common cutaneous side effects of anabolic steroids?

Answer 73

Common cutaneous side effects of anabolic steroids include acne vulgaris, hair growth on the body and loss on the scalp, striae from muscle hypertrophy, increased body hair, increased oil in the skin and hair, and premature androgenetic alopecia.

Question 74

What are the systemic side effects associated with anabolic steroid use?

Answer 74

Systemic side effects of anabolic steroid use may include hepatic enzyme elevations, jaundice, hypertension, and lipid abnormalities.

Question 75

What noncutaneous issues are associated with illicit drug use?

Answer 75

Illicit drug use is associated with extensive noncutaneous issues, including bloodborne or sexually transmitted diseases (HIV and hepatitis B and C), well-established comorbidities of IV drug use, and premature mortality in young adults due to trauma and suicide.

Question 76

What is the key to managing drug use, abuse, and addiction?

Answer 76

The key to managing drug use, abuse, and addiction is early intervention as possible.

Question 77

What are some alternative treatments for drug addiction?

Answer 77

Alternative treatments for drug addiction include acupuncture and meditation.

Question 78

What are the potential effects of teenage anabolic steroid use?

Answer 78

Teenage use can induce precocious puberty and growth stunting.