Mothers Against Misuse and Abuse - A Rational Approach to the Issues of Drug Use.

Over the last seventy years, the number of drugs that can be obtained has increased tremendously. While the term "drug culture" may have been appropriate for the 1960’s, a better phrase for today might be "drug technology". This technology has improved the quality of life for many and extended life for countless others. However, without proper education it can also cause great harm.

There are currently more than 100,000 brand name prescription drugs and 300,000 over-the-counter brand names available in drug stores. Use of alcohol, tobacco and caffeine is extensive.

Many of these products are extensively marketed to medical professionals and the public. Prescription drugs, once merchandised only to doctors and pharmacists, are now aggressively promoted to the general public. Retail drugs sold over-the-counter are advertised in both electronic and print media. Advertisements for alcohol, nicotine and caffeine are widespread and until recently, government subsidies encouraged production of tobacco. People also choose to use unregulated, illegal drugs, which have additional health and legal risks.

As the variety of drugs has increased, their power and use has also increased, but there has NOT been an increase in knowledge or decision-making skills that could reduce misuse and abuse. Most of the public has little access to accurate information on these substances. Instead of encouraging knowledge and informed decisions, the government, media, and well-intentioned citizens groups have engaged in sensational, inaccurate, and emotion-laden rhetoric. These approaches have not stopped the misuse and abuse of drugs, or their increasing availability.

Our society has promoted a vast drug technology, but does not teach people how to make responsible choices about use, or how to reduce risks and hazards if a drug is used. This is true whether the drug is legal or illegal.

Drug Consumer Safety Guidelines

MAMA recommends a seven step process to manage the risks of using a drug.

An Important Note of Caution - These guidelines are offered as a way of REDUCING RISK. They cannot, and will not ever make a drug safe. There is no such thing as a "safe" drug. All drugs produce side effects, and on occasion can produce dangerous adverse reactions. All drugs can potentially produce an overdose and may interact with other drugs which are being taken. The best that can be obtained in any drug-use situation is a reduction of risk.

That said, the drug consumer safety guidelines are:

2. Determine where it is working in your body (main effects, side effects and adverse reactions).

4. Realize what drug interactions will occur with what you eat, drink, or other drugs you may be using.

Click here for a printable poster showing these guidelines (Adobe Acrobat required)

In order to make a responsible decision about drug use; one must first determine what chemical is being considered. Once that is known, one can evaluate the benefit versus the risk of taking the drug. If the decision is made to take a drug, one must be able to recognize possible negative effects, and deal with them should they occur.

Because most drugs are sold by brand name, it is sometimes difficult to determine the exact chemical or generic name of the product. Without knowing the chemical name, it will be difficult for you to get the information about the drug that you need. Chemical or generic names may be gotten from physicians and pharmacists, drug information centers, drug abuse treatment centers, and crisis hotlines.

For combination products containing more than one chemical, you should get a complete list of all generic ingredients.

Receptor sites are places in the body to which a drug is attracted and where the drug's effects will be produced. When a drug arrives at a receptor site, it can produce one of three possible actions. The drug might produce the desired MAIN EFFECT, an automatic SIDE EFFECT, or a more rare and dangerous ADVERSE REACTION.

Drugs work at more than one site in the body. At one action site in the body, the drug may produce a desired or beneficial effect. This is called the "main effect" of the drug, and is why the drug is used. At the same time, the drug is attracted to other sites in the body where it can produce undesirable actions known as "side effects". Side effects occur whenever a drug is taken, and may range from mild reactions that are barely noticed, to severe reactions which require discontinuing the use of the drug.

Side effects are confusing to the public. Many assume that when a drug produces a side effect, it indicates that the drug is not working properly. In fact, side effects indicate that the drug is being very effective in reaching its receptor sites, even if the effects are not desirable. Side effects are also confusing because many drugs produce more than one side effect, and the intensity may vary from person to person.

In addition to main effects and side effects, drugs may also produce a rare and dangerous "adverse reaction". Adverse reactions indicate that the drug is not working properly at a receptor site, or that the drug is working at a receptor site that it is not supposed to.

If a drug produces activity other than the known main effects and side effects, you should presume that an adverse reaction is occurring. Use of the medication or drug should be terminated and a physician consulted immediately. To use a drug safely, you must know enough about the effects of the drug to distinguish between common side effects, and dangerous adverse reactions.

Many people do not ask critical questions before deciding to use a medication or drug. Many individuals obtain inaccurate or incomplete information from friends, or do not look beyond media advertising of a product. A logical and safer choice is to call a pharmacist, physician, or drug information center. Ask for the identity of the chemical being taken, its effects, and all the risks the drug will produce if taken.

People make decisions to take drugs. Whether it is a patient following a doctor's prescription, a consumer choosing an over-the-counter product, a customer purchasing a six-pack at the grocery store, or a young adult using marijuana or cocaine. All of these people are making decisions.

Medical professionals are legally liable if they prescribe a drug and cannot show that the benefits outweigh the risks. This is an excellent standard for you to use in making responsible drug-use decisions - Will the benefit of using this drug clearly outweigh the risk of known side effects and adverse reactions?

Some individuals and situations require greater care in deciding whether a medication or drug is used. Pregnant women should carefully evaluate the potential for fetal damage or birth defects, especially if the drug is used during the first three months of pregnancy. Nursing mothers should consult with physicians or pharmacists to determined if a medication will be passed to their infants. The elderly, due to declining health and physiology, may be more susceptible to side effects and adverse reactions. Street drugs may be improperly produced or contain hazardous ingredients.

Some medications - alcohol, nicotine, caffeine, and street drugs - have their main effects on the central nervous system. Drugs that produce effects on the central nervous system are called "psychoactive". Substance abuse professionals state that extensive use of psychoactive drugs by adolescents can impair academic and social development. The effects of psychoactive drugs can be influenced by the situation in which they are used (e.g. stress) and by the user's expectation of what effects the drug will produce.

If a decision is made to use a substance, the next three guidelines are critical for consumer safety. The public has not been taught that drug dosage and interactions are significant risks, making them leading causes of death from legal and illegal drugs.

Dosage is the most complex and important factor in using a medication or drug, and is the most frequent cause of serious injury or death. Most of the public assumes that dosage means, "How much do I take?" This is a dangerous simplification of a sophisticated question.

When drugs are researched to determine main and side effects, they are administered in concentrations relative to the body weight of animal and human subjects. The goal is to determine the precise concentration in the body that will produce the maximum main effect and minimum of side effects. This concentration is called the milligram per kilogram (mg/kg) for that drug. This dosage indicates the proper amount of drug to administer given how much a person weighs. Each drug has its own mg/kg ratio to produce the maximum benefits with the lowest risk. Physicians and pharmacists use this information in prescribing a therapy. It would also be a good idea for the public to understand and employ this concept.

Using an mg/kg standard will NOT STOP the side effects, which occur with all drugs. Instead it will help reduce the incidence and severity of side effects and adverse reactions.

After dosage by body weight, it is also important to understand the way drugs are taken. Drugs that are injected arrive at receptor sites in the body very rapidly and at full strength. This is quite different from swallowing a drug where it must first go through the stomach, be absorbed in the intestines, and go through the liver before reaching action sites. This process may take 30 to 45 minutes from the time it is ingested. Food and drink in the stomach can delay the onset, or reduce the amount of a drug that is absorbed.

The final concern about dosage involves timing. You should determine how long a drug will produce effects to ensure that a medication does not interfere with work or driving. For prescribed medications, try to pin down the hour when the drug should be taken, and if it should be taken before, after, or with meals.

A drug interaction can occur when two or more drugs are taken together, or when one drug's effects overlap those of another drug. Since many people take a prescription medication, an over-the-counter product, and also use drugs such as nicotine, caffeine, and alcohol, drug interactions are a true concern. Drugs may negate or enhance the effects of other drugs.

A common and potentially lethat drug interaction is called SYNERGISM. This reaction occurs when depressant drugs are mixed together, producing dramatic increases in the intoxicating, sedating, and respiratory effects of these drugs. An example of synergism would be mixing alcohol with other depressants such as sleeping pills, major pain relievers, tranquilizers, muscle relaxers, or antidepressants. This may cause a lethal depression of the respiratory system.

Other drugs can act in an additive fashion creating a slight increase in the drug's effects. This can occur when caffeine and other stimulants are taken together. There can also be antagonistic reactions, in which one drug may negate the effects of another. Antagonistic reactions are often misunderstood by the public. A common example of this mistake is to assume that stimulants can counteract the effects of depressants, such as alcohol. While stimulants may increase alertness, they do not counteract the impairment of coordination and judgement that alcohol produces. Stimulants only produce a slightly more alert drunk.

Allergic reactions are sometimes called the "wild card" of drug technology, because experts are not sure what causes them or when they are likely to occur. Fortunately the incidence of severe allergic reactions is small, perhaps 3-5% of the population for any particular drug.

There are early warning signs that can indicate if a person is allergic or hypersensitive to a drug. If shaking or tremors occur in the arms, legs, or body after taking a drug, its use should be immediately discontinued and the individual taken to the emergency room. Such tremors can progress to epileptic-type seizures.

Another form of allergic response is impaired breathing. If a drug or medication produces difficulty in breathing, its use should be discontinued and the person taken to an emergency room immediately. In severe cases artificial respiration may be required on the way to the hospital.

Other allergic reactions are not life threatening, but can be unpleasant. If you notice a rash or swelling after taking a medication, consult a physician or hospital. A final allergic response could be severe stomach irritation or distress when a medication is used. Discontinue use of the drug and consult a physician or hospital to determine if anti-nausea medications are necessary.

If a person uses a drug on a frequent, regular basis, the final two guidelines are necessary to prevent problems due to habituation and dependence.

Drug tolerance means that if a drug is used frequently over time, increasing dosages will be required to produce effects similar to when it was first used.

When a drug is taken into the body, it is eventually eliminated by enzymes in the liver that break it down. This allows the kidneys and intestines to eliminate the drug from the body in a few hours or days. If a drug or medication is used frequently, the liver becomes more efficient at breaking down the drug. In addition, the receptor sites for the drug may become desensitized to the normal dosage. A person using a drug on a frequent basis soon notes that the normal dosage of the drug is not producing the desired effect. A larger dose will now be needed to produce the original effects.

While increasing doses are required to produce the main effect of the drug, tolerance may not be developing for side effects, which may even become more severe. Also, as dosage is increased due to frequent use, the overdose level does not necessarily change. A person continuing to increase dosage because of tolerance may be coming closer to the overdose level. In the case of street drugs such as opiates, as tolerance increases, larger amounts of money are needed to produce the desired effect.

For drugs that produce tolerance, it is necessary to exercise caution in frequency and duration of use. Tolerance really implies that many drugs cannot be used on a regular or frequent basis, especially for recreational effects. There are natural limits to drug technology that cause harm if they are ignored. Since many drugs take 2-3 days to be eliminated from the body, the recreational use of any drug on a daily basis or near-daily basis is unwise. Drug experts suggest becoming familiar with alternative activities that provide enjoyment and recreation. Many citizens need to strike a better balance between drug usage and alternative activities to drugs. Communities that promote such activities to youthful populations are more likely to achieve a reduction in drug misuse and abuse problems.

If a drug is frequently abused, drug dependence may occur, producing severe withdrawal reactions if the use is suddenly discontinued. With some drugs such as alcohol, barbiturates, and tranquilizers, withdrawal reactions may be life threatening without medical supervision. Other drugs such as opiates - codeine, heroin, and morphine- and synthetic opiates - propoxyphene (Darvon) and meriperidine (Demerol) - may produce extremely unpleasant withdrawal reactions but will not be life threatening.

Physical dependence to a drug usually requires an individual to have built a large tolerance from high-dose, frequent use. As extensive use causes an emerging drug tolerance to develop, larger amounts of the drug are taken into the body. The body compensates and eventually becomes dependent on the presence of these large amounts of the drug for normal functioning. Withdrawal reactions occur when the available drug in the body has been metabolized, and the user fails to take more.

Individuals vary in their susceptibility to dependence, and many substance abuse professionals believe that some individuals may become dependent even during early or initial use. Alcohol and other drug studies indicate that one out of every ten persons may become physically or psychologically dependent.

Psychological dependence is not well defined or easily communicated. Mental health experts indicate that any behavior that is pleasant may be excessively used by some individuals, even if moderate or excessive use has negative consequences. There are some individuals who have difficulty controlling a desire for immediate gratification. When thinking about a drug, the desire for the immediate pleasure sensations dominates, despite the known negative effects. Such individuals may become habituated or psychologically dependent on a drug, even though physical dependence is not present.

In many ways the issue of drug abuse comes down to individual responsibility. Social and governmental efforts of reduce drug misuse and abuse are usually ineffective unless citizens take responsibility for their own health. Once individuals have decided to be responsible for themselves, they need information and an understanding of the risks involved. MAMA's drug consumer safety guidelines have been written to provide you with this much needed information and education. These guidelines also provide a framework for consumers to use in asking questions of physicians and pharmacists to ensure responsible use of a medication.