Pharmacophore an International Research Journal
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Open Access | Published: 2022 - Issue 3


Nahi Sobeih Qassem AlRuwaili1*, Alanazi Abdullah Tban Mohammad2, Hayat Faisal Saleh Alnathir2, Mariam Hamad Saleh Alfeheid3, Nada Naif Zuqm Alshammari2


  1. Department of Psychiatrics, Eradah Complex for Mental Health (ECMH - NB), Arar, Saudi Arabia.
  2. Eradah Complex for Mental Health (ECMH - NB), Arar, Saudi Arabia.
  3. Faculty of Medicine, Northern Border University, Arar, Saudi Arabia.


Over the preceding 10 years, fatalities of the groups of individuals who use substances and those who are made homeless in the United Kingdom (UK) have grown massively. The world is now more conscious of how prescription opioid drugs may give a bad impact, like as overdose fatalities and addiction, thanks to the current opioid epidemic in North America. Recent health policies and therapeutic recommendations for the management of chronic noncancer pain are based on a "pharmacovigilance" paradigm, which has expanded specialized care for all chronic pain patients' overdose and dependence management strategies. Thus, physicians agreed on recommendations not to prescribe opioids for chronic noncancer discomfort to people with a history of substance use. These restrictive events have strengthened the boundary between people categorized as “genuine” chronic discomfort patients and those categorized as “drug addicts” who are believed to be more likely to misuse opioid medication. Intoxications frequently cross hand-in-hand with behavior, as they could both be the challenge of dependency or the propelling issue to behavioral disruptions and suicidal tendencies. For that reason, consult with the following listing of intoxications/overdoses and their respective cures.

Keywords: Illicit drugs addiction, Chronic diseases, Intoxication, OPIOIDS


The layman`s definition of dependency is a "reality or situation of being hooked to a selected substance, thing, or activity." Medically its miles a "chronic, deteriorating sickness characterized through compulsive drug seeking, steady use notwithstanding dangerous consequence, and long-lasting modifications inside the brain. The idea reveals connotation inside the relinquishment of management through the "addicted" individual matching how drug-established patients succumb to the cravings for his or her drug of choice. Dual predominant principles of dependency contain substance compulsion (drug dependency), that's a neuropsychiatric sickness characterized by a repeating need to take a drug constantly notwithstanding the drug's dangerous penalties [1].

The usage of opioid painkillers by individuals with persistent non-cancer pain has increased during the past 15 years. However, the abuse of opioid medicines is a serious public health issue [2, 3]. According to national polls, the abuse of opioids has drastically grown over the past several years, surpassing the abuse of cocaine and heroin as the most common drugs. Significant increases in the number of unintended overdose deaths caused by opioid analgesics diverted from future medical use have been seen in Utah and North Carolina [4, 5].

Over the past ten years, deaths among the populations of persons who inject drugs (PWID) and those who become homeless in the United Kingdom (UK) have increased rapidly (ONS, 2019a, 2019b). Although UK surveillance statistics demonstrate increases in mortality, morbidity, and the burden on the health system due to infections from injecting, they offer little insight into the social and environmental factors influencing health harm risk and treatment accessibility. This study uses mixed-method data collected from 455 PWID, many of whom report hard sleeping and hospitalization due to injecting, to examine the undercurrents of medical care seeking and avoidance among the most marginalized. The demographics in the example are similar to the PWID reported in the UK inquiry data. Deaths among the populations that use drugs interchangeably Results from a subsample of review participants' qualitative accounts are highlighted in the findings to highlight the seriousness of health problems that are integrated into everyday life as well as the structural factors that contribute to maintenance delay [6].

The public is now more aware of how prescription opioid drugs can hurt, including overdose fatalities and addiction, thanks to the current opioid epidemic in North America. The concept of "pharmacovigilance," which has led to enhanced monitoring of overdose and addiction risk factors for all patients with lingering effects, underpins modern health policies and medical standards for the treatment of long-lasting noncancer pain. As a result, doctors are advised against recommending opioids to patients who have a history of substance abuse for persistent noncancer pain. Deaths among the populations that use drugs interchangeably Results from a subsample of review participants' qualitative accounts are highlighted in the findings to highlight the seriousness of health problems that are integrated into everyday life as well as the structural factors that contribute to maintenance delay [6].

These restrictive measures have made it clearer which individuals are "true" chronic pain sufferers and which are "drug addicts," who are more inclined to abuse opioid medications [7]. According to studies, there is a significant rate of poly-morbidity among inmates, with substance addiction, mental disorders, and infectious diseases being the most prevalent health issues. Substance misuse and dependency are widespread issues among those incarcerated. It is not unusual to see 1 in 3 or even 1 in 2 prisoners who abuse or are dependent on drugs. In jails, drinking and smoking are also widespread problems [8].


The study aimed to summarize the updated evidence concerning the prevalence, risk factors, management, and outcome of treatment of illicit drug addiction among patients with chronic diseases.

Materials and Methods

Study Design

Simple Review article.   

Study Duration

Data was collected during the period from 1– 29 May 2022.

Data Collection

PubMed and EBSCO Information Services was chosen as the search databases for the publications used within the study. Topics concerning the updated evidence concerning the prevalence, risk factors, management, and outcome of treatment of illicit drug addiction among patients with chronic diseases, published in English around the world. The keyword search headings included “illicit drugs, addiction, drug addiction in chronic diseases", and this combination will be used. Search the reference list of each included study for supplementary supporting data. A double check of the results for each member was applied to ensure validity.


Statistical Analysis

No software was used for the data's statistical analysis. According to the goal of the study, the data was extracted. The group members will examine these facts to get to their initial conclusions. To guarantee the validity and reduce errors, the results of each member were double-revised.

Etiology of Illicit Drugs Addiction

The genesis of substance abuse, alcoholism, and other drug use disorders is influenced by a complex interplay of neurobiology, heredity, and environment (nature and nurture) (AODUD). A well-known indication that supports the neurological basis of addiction is reward activation. Observations that tie the dopamine reward system to reliance may not, however, rule out or minimize the role that memory and learning in the hippocampus and emotional guidance in the amygdala may have in the emergence and maintenance of a dependency [8-10].

The signaling pathway Delta-FosB was used to suggest that heredity might play a role in addictive behavior. One of the mechanisms through which drug usage might alter the brain and contribute to the addiction phenotype may be delta-FosB.

Epidemiology of Illicit Drugs Addiction

Synthetic opioids are illegally manufactured substances that are chemically resemble to older painkillers or psychoactive drugs. These medications may have greater potency than known regulated or illegal narcotics. International concern over the production and distribution of counterfeit pharmaceuticals to get around drug regulations and escape interdiction is rising. Depending on the locale, designer medications are always evolving. They include synthetic stimulants like bath salts, a synthetic cathinone, k2 or spice, a norepinephrine-dopamine reuptake inhibitor, and flakka, a member of the cathinone and pyrovalerone groups, as well as synthetic designer hallucinogens like N-bomb and Solaris [11].

Pathophysiology of Illicit Drugs Addiction

Long-time period potentiation (LTP) and LTD are examples of synaptic malleability, which are essential to the pathophysiology of addiction (lasting depression). The phenomena of neural networks turning into more potent over the years and in reaction to greater stimuli are referred to as long-time period potentiation. Reduced mind sign reaction to a stimulus is a sign of long-time period depression. These are the identical strategies engaged in addiction formation and learning. Extracellular sign-regulated protein kinase (ERK), cyclic AMP reaction element-binding (CREB), ELK-1, and FosRats handled to overpower ERK stopped favoring the caged vicinity with cocaine over the crate vicinity with ordinary saline. This is organic proof that those strategies are concerned with drug addiction. Consequently, the levels of CREB, ELK-1, and Fos are all reduced; each of these genes is recognized to be complicated with LTP and drug abuse [12]. Biochemistry experiments have demonstrated the involvement of the dynorphin A (DYN) and K-opioid receptor (KOPr) systems [13]. Dopamine has also been linked in the study as a key factor in the neurologic irregularities in an addict's brain. The onset and persistence of reliance were linked to large and rapid escalation [14].

Treatment of Illicit Drugs Addiction

Neurotoxic effects frequently coexist with addictions because they can be either the addiction's target or the catalyst for behavioral problems like suicidal thoughts. Refer to the list of intoxications/overdoses and their corresponding treatments that follow for further information. Additional treatment is keeping an eye on and sustaining the patient vital signs. Once more, this depends on the content of the habit and the point at which it is being presented as persistent. While there are many pharmaceutical therapies available for smoking and drinking, the two most similar drug addictions, group meetings, and psychological and social support are by far the most effective. Alcohol dependency can be treated pharmacologically with disulfiram, naltrexone, and acamprosate. Each has a place in alcoholism and alcoholism as a habit. Disulfiram is useful for patients who have just stopped using drugs and need assistance maintaining their sobriety since any alcohol ingested would quickly result in symptoms that are intended to discourage continued drinking. Acamprosate decreases the first withdrawal symptoms as you work toward being abstinent, while naltrexone eliminates the feeling of reward or pleasure associated with consumption to help you start and maintain abstinence. Long-acting benzodiazepines like chlordiazepoxide or diazepam can be used to treat acute alcohol intoxication during relapse episodes [15]. Presently, two drugs can be used to treat tobacco dependence: bupropion and varenicline [16].

Differential Diagnosis of Illicit Drugs Addiction

When it comes to dependencies, the differentiation should take into account excluding the cause of the addiction. Root causes that could exist are like shadows. Moreover, over half of the individuals with substance misuse illnesses have bipolar disorder, which can cause the patient to experience severe mood swings.

Post-traumatic stress disorder (PTSD) should be evaluated for all addicts since it is prevalent comorbidity among whiskey abusers. Even though the two disorders are distinct and have their signs and symptoms, treating PTSD at its core can lessen or even cure the underlying obsession.

Since bouts of altered mental state are common in situations of intoxication, the following is a helpful mnemonic for emergency department doctors: I-insulin (hypoglycemia, HHNK, DKA); O-opiates, oxygen; U-uremia; 2 E-encephalopathy (hypertensive, hepatic), electrolytes, endocrine, and environmental [1].

Prognosis of Illicit Drugs Addiction

The long-term repercussions of drug use are extremely evident, with individuals with diagnoses dying 22.5 years sooner than those without diagnoses. The cardiac, respiratory, and neurological systems are only a few of the many systems that chemicals can have a hazardous effect on. Additionally, a five-year study on drug and alcohol rehab indicated that older persons fared better than young adults in the long run; in particular, older adults (particularly older women) had higher 30-day self-denial rates, at 52% compared to 40% for younger ones [17]. Along with age, other factors such as social networks and masculinity play a part in these statistics [18, 19].

Complications of Illicit Drugs Addiction

Wernicke encephalopathy and Korsakoff syndrome are predicted side effects of persistent alcohol consumption. Confusion, ophthalmoplegia, and ataxia are the three symptoms of Wernicke encephalopathy (though often, just one of these is present 20% of the time). The bilateral mammillary bodies and hippocampus regions withering on CT and MRI images are examples of typical findings [20, 21]. Subsequent identified effect of long-term alcohol consumption is cardiomyopathy, which is anticipated due to oxidative stress, interference with calcium management, and mitochondrial dysfunction [22, 23].

Cocaine use and overdose cause cardiac ischemia, insanity, and fatal arrhythmias that need to be managed quickly to prevent property loss [24, 25].

Predictive Risk Factors

A complicated interaction between the separate, agent (drugs and alcohol), and the environment leads to addiction. Interactions between social, cognitive, cultural, attitudinal, character and developmental aspects strongly influence the start of first drug use. The family may be one of the first sources of influence for smoking, drinking alcohol, or using drugs. Poor self-image, low religiosity, poor academic achievement, parental rejection, dysfunctional families, abuse, under or over-controlling by parents and separation are all associated with drug use throughout adolescence [26].

Living with Injection Injury and Illnesses

Discernment into the circumstances influencing SSTI risk and maintenance delay is provided by participant stories of living with injecting-related injury and illness. Many people cite hypodermal and femoral vein injections, as well as homelessness—not as descriptive terms, but rather as the background of lifestyles that frequently include sickness while eschewing medical care. Numerous testimonies terrify with a visceral intensity and draw attention to challenges that the author was unaware of. For instance, four male individuals described spontaneous bloody groin eruptions, indicating a femoral insertion injury [6].

Substance Abuse and Illicit Drugs Addiction in Children

There are several negative health and safety hazards for the kid, family, and society as a result of alcohol and other drug use in broods, both directly and indirectly. A first step in addressing the issue of drug use in the pediatric population is developing an understanding of the risk and protective variables that may influence the emergence of substance addiction. In addition to a list of accessible preventative databases for kids of all ages, this article summarizes the research on the prevention, detection, and anticipation of drug misuse in the pediatric population.

The risk of significant health effects and adult substance misuse increases the younger a kid starts drinking and using other drugs. One of the main avoidable causes of death for people between the ages of 15 and 24 is accidental and purposeful deaths linked to drug and alcohol usage in the teen population. Adolescent residents who use alcohol and other drugs run a higher chance of becoming delinquent, being pregnant as teenagers, and being unhappy. Accidental drug exposure in young children has led to several health issues, including respiratory conditions, convulsions, changed mental state, and even death [27].


Current and ongoing large-scale surveys of complaints about alcohol and drug use are insufficient for examining high-spending individuals with complicated healthcare needs. In healthcare settings, it is essential to use the EHR data to identify and describe individuals with multi-morbidity. This study is among the first to analyze painstakingly multi-comorbidity of alcohol/drug use disorders and chronic diseases and its connection with hospitalization, albeit conclusions are confined by information from one big health system. By using the existence of SUD (including drug use disorders) as a reliable predictor of hospitalization that is independent of the number of concomitant chronic conditions, it adds clinical evidence. The findings underscore the clinical importance of and need for pick up the check alcohol/drug use disorders like other chronic conditions with practical, chronic-care model approaches to enhance treatment engagement, adherence to routine, self-management skills, and the continuity of upkeep.

Acknowledgments: Many thanks to Dr. Nahi Sobeih Qassem AlRuwaili: Consultant of psychiatry, Eradah Complex for Mental Health, Arar, Saudi Arabia., for his continuous help, support and encouragement to complete this work.

Conflict of interest: None

Financial support: None

Ethics statement: None


1.        Fluyau D, Charlton TE. Drug Addiction. 2022 Apr 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

2.        Melzack R. The tragedy of needless pain. Sci Am. 1990;262(2):27-33.

3.        Gilson AM, Ryan KM, Joranson DE, Dahl JL. A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997–2002. J Pain Symptom Manage. 2004;28(2):176-88. doi:10.1016/j.jpainsymman.2004.01.003

4.        Ballesteros MF, Budnitz DS, Sanford CP, Gilchrist J, Agyekum GA, Butts J. Increase in deaths due to methadone in North Carolina. JAMA. 2003;290(1):40. doi:10.1001/jama.290.1.40

5.        Caravati EM, Grey T, Nangle B, Rolfs RT, Peterson-Porucznik CA, Centers for Disease Control and Prevention. Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003. MMWR. 2005;54(2):33-6.

6.        Harris M. Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care. Soc Sci Med. 2020;260:113183. doi:10.1016/j.socscimed.2020.113183

7.        Dassieu L, Kaboré JL, Choinière M, Arruda N, Roy É. Painful lives: Chronic pain experience among people who use illicit drugs in Montreal (Canada). Soc Sci Med. 2020;246:112734. doi:10.1016/j.socscimed.2019.112734

8.        Moschetti K, Stadelmann P, Wangmo T, Holly A, Bodenmann P, Wasserfallen JB, et al. Disease profiles of detainees in the Canton of Vaud in Switzerland: gender and age differences in substance abuse, mental health and chronic health conditions. BMC Public Health. 2015;15(1):1-1.

9.        Shaffer HJ, LaPlante DA, LaBrie RA, Kidman RC, Donato AN, Stanton MV. Toward a syndrome model of addiction: Multiple expressions, common etiology. Harv Rev Psychiatry. 2004;12(6):367-74.

10.     Blum K, Oscar-Berman M, Demetrovics Z, Barh D, Gold MS. Genetic addiction risk score (GARS): molecular neurogenetic evidence for predisposition to reward deficiency syndrome (RDS). Mol Neurobiol. 2014;50(3):765-96.

11.     Koob GF, Le Moal M. Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology. 2001;24(2):97-129.

12.     Gould TJ. Addiction and cognition. Addict Sci Clin Pract. 2010;5(2):4-14.

13.     Shippenberg TS, Zapata A, Chefer V. Dynorphin and the pathophysiology of drug addiction. Pharmacol Ther. 2007;116(2):306-21.

14.     Volkow ND, Fowler JS, Wang GJ. The addicted human brain: insights from imaging studies. J Clin Investig. 2003;111(10):1444-51.

15.     Gatch MB, Lal H. Pharmacological treatment of alcoholism. Prog Neuropsychopharmacol Biol Psychiatry. 1998;22(6):917-44.

16.     Aubin HJ, Luquiens A, Berlin I. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol. 2014;77(2):324-36.

17.     Scott CK, Dennis ML, Laudet A, Funk RR, Simeone RS. Surviving drug addiction: the effect of treatment and abstinence on mortality. Am J Public Health. 2011;101(4):737-44.

18.     Satre DD, Mertens JR, Areán PA, Weisner C. Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program. Addiction. 2004;99(10):1286-97.

19.     McKenzie SK, Collings S, Jenkin G, River J. Masculinity, Social Connectedness, and Mental Health: Men's Diverse Patterns of Practice. Am J Mens Health. 2018;12(5):1247-61. doi:10.1177/1557988318772732

20.     Flynn A, Macaluso M, D'Empaire I, Troutman MM. Wernicke's Encephalopathy: Increasing Clinician Awareness of This Serious, Enigmatic, Yet Treatable Disease. Prim Care Companion CNS Disord. 2015;17(3).

21.     Skok H, Jabour J, Betcher J. Wernicke Korsakoff syndrome in a teenage female as a complication of COVID-19. J Am Coll Emerg Physicians Open. 2022;3(3):e12735. doi:10.1002/emp2.12735

22.     Rehm J. The risks associated with alcohol use and alcoholism. Alcohol Res Health. 2011;34(2):135-43.

23.     Steiner JL, Lang CH. Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apoptosis. Int J Biochem Cell Biol. 2017;89:125-35. doi:10.1016/j.biocel.2017.06.009

24.     Karila L, Lowenstein W, Coscas S, Benyamina A, Reynaud M. Complications of cocaine addiction. Rev Prat. 2009;59(6):825-9.

25.     Ouali S, Guermazi O, Guermazi F, Halima MB, Boudiche S, Khedher N, et al. Drug abuse-induced cardiac arrhythmias: mechanisms and management. Card Arrhythmia. 2018. doi:10.5772/intechopen.76022

26.     Jessor R, Jessor SL. Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic Press; 1977.

27.     Belcher HM, Shinitzky HE. Substance abuse in children: Prediction, protection, and prevention. Arch Pediatr Adolesc Med. 1998;152(10):952-60. doi:10.1001/archpedi.152.10.952


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