Substance Use Disorders
Any pattern of substance use causing significant physical, mental, or social dysfunction
- Substances of abuse include:
- Cannabis (marijuana, hashish, cannabis oil, extracts); also sold as highly concentrated extracts for use in vaporizers
- “Club drugs” (MDMA [ecstasy, Molly], PMMA [Superman], flunitrazepam, γ-hydroxybutyrate [GHB])
- Dissociative drugs (ketamine, phencyclidine [PCP], tenocyclidine [TCP])
- Hallucinogens (lysergic acid diethylamide [LSD], salvia, ayahuasca, N, N-dimethyltryptamine [DMT])
- Inhalants (glue, paint thinners, nitrous oxide)
- Opioids (carfentanil and other synthetic analogs of fentanyl, heroin, kratom, desomorphine [Krokodil], U-47700 [Pink])
- Prescription medications
- CNS depressants (barbiturates, benzodiazepines, hypnotics)
- Dextromethorphan (“Robotripping”)
- Opioids and morphine derivatives (fentanyl, hydrocodone, oxycodone, others)
- Stimulants (amphetamines, methylphenidate)
- Stimulants (cocaine, amphetamines, methamphetamines, khat)
- Synthetic cannabinoids (Spice, K2, fake weed); often much more potent than marijuana; may be smoked or vaporized
- Synthetic cathinones (bath salts, alpha-PVP [Flakka])
- Predominant age: 18 to 25 years
- Predominant sex: male
- 59.3 million Americans (21.4%) reported illicit drug use in the past year in 2020.
- 13.8% of 12- to 17-year-olds; 37.0% of 18- to 25-year-olds
- 1 in 3 (34.5%) young adults used marijuana in the past year.
- Opioid overdose is the leading cause of death for persons 26 to 38 years of age in the United States. More than 80% of these are due to synthetic opioids.
- Many states require naloxone to be prescribed or offered when issuing a prescription of opioids to patients at increased risk of overdose, such as those receiving ≥50 morphine milligram equivalents per day of an opioid, those taking both opioids and benzodiazepines, and those with a history of substance abuse.
Etiology and Pathophysiology
Substances of abuse affect dopamine and other neurotransmitter receptors. Variant alleles may account for differences in susceptibility to misuse of different substances.
- Academic problems, school dropout
- Criminal involvement
- Depression, anxiety
- Family dysfunction or trauma
- Family history
- Peer or family use or approval
- Unemployment, low socioeconomic status
- Early identification and aggressive early intervention improve outcomes.
- Universal school-based interventions are modestly effective for prevention.
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