Substance Abuse

“Substance abuse is of great importance in society and with respect to the dental and medical profession. Don’t just think of patients or friends who are using illegal drugs, but dentists are getting in trouble for over-prescribing drugs with hydrocodone and oxycodone in them, among others. These drugs have street value, as practitioners you must be aware of patients’ potential drug seeking behaviors”


Tolerance refers to a reduced drug effect with repeated use and a need for higher doses to produce the same effect.

Dependence is characterized by physiological and behavioral change, probably manifested when the drug is discontinued; we use the word habituation. “I am habituated to caffeine, if I don’t get some caffeine in the morning I will show some malaise in the early morning – I have a headache and general malaise that is taken care of when I drink a cup of coffee.”

Physical dependence is manifested by a characteristic syndrome of signs and symptoms during withdrawal, commonly encountered when someone quits “cold turkey” or suddenly ceases taking a drug that he has become habituated to (i.e., suddenly stopping cigarette smoking.

A precipitated withdrawal refers to the fact that an MD can use drugs that can block or antagonize and reverse the effects of a drug class. So if a pt is addicted to an opiate and a doctor was to inject Narcan or Naloxone or any opiate antagonist you would precipitate withdrawal.

Cross dependence is when different drugs within a pharmacological class can maintain physical dependence produced by other drugs in the same class. For example if a pt is dependent upon hydrocodone (found in Vicodin) and you substitute some other narcotic (it may be synthetic or a natural opium derivative) there is cross dependence. Its analogous to being allergic to aspirin AND ibuprofen and naproxen or any other anti-steroidal… aspirin is a salicylate and the other class is structurally different and we know that there is cross reactivity within a broad class independent of chemical structure.

Category: Pharmacology Notes