Novel Psychoactive Substances - PDF

The Pharmacology of
Psychoactive substances

TABLE OF CONTENT
INTRODUCTION...........................................................................................................................1
CASE STUDY ................................................................................................................................1
1. Physiological and biological impact of substance abuse ........................................................1
2. Pharmacology of drugs taken by Amy Winehouse .................................................................2
3. Pharmacodynamic properties of psychoactive substances .....................................................2
4. Benefits and harmful impact of drug interactions ...................................................................2
5. Effect of drug interactions on life of Amy Winehouse ...........................................................3
6. Role of pharmacotherapy at various stages.............................................................................4
7. Pharmacotherapy interventions ...............................................................................................4
8. Critical evaluation of interventions .........................................................................................5
CONCLUSION ...............................................................................................................................5
REFERENCES ...............................................................................................................................7

INTRODUCTION
Substance abuse is defined as the use of psychoactive substances, illicit drugs and alcohol
in harmful way which has adverse impact upon physiological and mental health, social
relationships as well as professional efficiency. The addiction to these substances can be life
threatening and thus it is essential that pharmacological actions and interventions for these
substances must be understood (Jamison & Mao, 2015). The report will discuss the case study of
Amy Winehouse who was one of the most successful English songwriter and singer. The young
singer was addicted of alcohol and opioids which not only destroyed her professional growth but
also resulted in her death. The study will discuss the pharmacotherapy interventions and actions
of drug consumed by Amy Winehouse which caused her untimely death.
CASE STUDY
1. Physiological and biological impact of substance abuse
The alcohol and opioid addiction of Amy Winehouse caused several vulnerabilities
which complicates the drug consumption. Due to the influence of substance abuse she was not
able to tolerate the use of drugs and it becomes her necessity for the comfort. The key
physiological effect is shown in the form of compulsive consumption of drug and alcohol so that
subjective effects like stress, craving and stress sensitivity. The excessive intake of drugs such as
opioid also made significant changes in brain in terms of poor or down regulation of specific
brain receptors. Thus substance abuse acts as major element in causing neural changes or brain
based alterations. The changes are also observed in terms of habits, behaviour and functionality
of various organs (Pergolizzi & et.al., 2017). For instance when Amy Winehouse was not able to
have drugs and alcohol then it caused stress, aggression as well as pain. Even when she tried to
withdraw from the drug she had to suffer several distressful and pain events.
Amy Winehouse had excessive intake of alcohol which caused pleasurable effects like
inhibition, sedation and euphoria. At the time of death the singer was found to have excessive
concentration of alcohol in blood. Excessive alcohol is also responsible for accidental injuries,
lack of consciousness, dysarthria and ataxia. Alcohol is distributed in body tissues having high
water concentration such as in skeletal muscles and brain (Sofuoglu, DeVito & Carroll, 2018).
Thus it affects the alcohol elimination and metabolism rate making its addiction more
demanding.
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2. Pharmacology of drugs taken by Amy Winehouse
The alcohol consumption as done by Amy Winehouse affected her brain by enhancing
the gama aminobutyric acid receptor which is known to be major neurotransmitter in the brain.
Thus alcohol consumption particularly in excessive limits is responsible for suppressing the
activities and functions of central nervous system. The alcohol intoxication produces effects such
as central nervous system depression, mood lift, cognitive and motor impairment. In long term it
also results in neurocognitive impairment, liver and brain damage and addictions (Hagedorn &
et.al., 2018). High amount of alcohol consumption in the blood can even lead to the death of
individual. The same was observed in the case of Amy Winehouse .
On the other hand opioid analgesics have complex interaction with the opioid receptors.
The consumption of opioid in excessive limits reduces the release of pre synaptic transmission,
disinhibition and hyper-polarisation of post synaptic elements. As a result of opioid action the
transient effects such as vomiting, nausea, sedation, life threatening respiratory depression,
urinary infection and pruritus are caused.
3. Pharmacodynamic properties of psychoactive substances
The psychoactive substances such as alcohol and opioids which were consumed by Amy
Winehouse are considered to be elusive which acts at cellular and molecular level. For instance
as compare to the opioids alcohol have low potency and causes effects at high concentration
only. The alcohol does not have any binding sites and has its potential impact upon ligand gated
ion channels which mediate its effect upon central nervous system. On the other hand opioid
such as heroine uses receptor signal transduction for enhancing the activation of signal pathway.
The key pharmacodynamic characteristics of opioid is the biased agonism and functional
selectivity which helps this drug to bind with the opioid receptors found in nervous system and
other body tissues. Opioid receptors are reversed by inverse agonist naloxone which exhibits
higher level of affinity bindings (de Andrade & et.al., 2018). The pharmacodynamic response of
the drug is also dependent upon binding receptor as well as associated affinity for that receptor.
The agonist and antagonist nature of the drug is also one of driving force which determines the
extent of drug response.
4. Benefits and harmful impact of drug interactions
The interaction of various types of drugs can result in the unexpected outcomes which
may or may not be harmful for the individual. There are various reasons which can cause the
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interaction of drugs. For instance one type of drug can affect the pharmacokinetics of another
drugs or can event cause competition for signal pathway or receptors. The drug interaction can
have both positive as well as negative impact on the health outcomes of the individual (de
Andrade & et.al., 2018). For instance in pharmacotherapy similar types of drugs are used which
interact with each other so that same neural impact can be produced and addiction can be treated.
The drug interactions not only occurs between drugs but it can also occurs with specific
medical conditions or food and beverages. For example in case of Amy Winehouse as she was
suffering from depression the intake of alcohol made her condition more severe (Topping, 2013).
The inability to control her addiction cause more stress and anxiety to her which added on to her
depression. The mixture of potentially harmful drugs such as excessive alcohol with opioids can
also result in the death of individual as their combination can have adverse medical
consequences.
5. Effect of drug interactions on life of Amy Winehouse
The alcohol and drug addiction affected both personal and professional life of the singer.
Amy Winehouse was in constant depression which even took the form of violent mood swings.
There were instances when she caused self injuries and experienced eating disorders. The drug
abuse also became a major issue with personal relationships. Drug abuses and her constantly
changing and aggressive mood swings caused her separation from love ones. The severe
depression and concerns also made it impossible for her to focus on her professional
commitments (Cunill & et.al., 2015). On many instances she used to take drugs and alcohol
during stage performances which was highly criticised by her audience.
With increasing depression and anxiety Amy Winehouse also struggled with severe
addiction. Thus when drugs or alcohol was not available to her it resulted in extreme anxiety and
physiological sufferings. The physical as well as psychological well being of singer was poorly
affected and lead to shameful affairs when her drug addiction became public during her stage
performance when she was not able to even stand properly. The drug interactions also caused
several complications such as weight loss, chest infections which caused repeated events of
hospitalisation (Fazel & et.al., 2016). The erratic and violent behaviour, respiratory issues,
depression and irregular heart beats caused her death.
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6. Role of pharmacotherapy at various stages
Pharmacotherapy is known as the treatment strategies for particular disorders or disease
using medications. There are specific medications which helps individuals to minimise the drug
or alcohol cravings and to lower the intensity of withdrawal symptoms. The relapse events for
drugs are also reduced by using these pharmacotherapy interventions. The neurobiological
alterations which were caused to Amy Winehouse by alcohol and opioid could have been
controlled by pharmacotherapy. Winehouse was willing to gave up on her addiction however due
to professional commitments and fear of harm to her public image she never agreed to go for the
rehabilitation centres.
In such situations it was required that effective pharmacotherapy was available to
Winehouse so that it was possible for singer to overcome her addiction (Rolland & Naassila,
2017). Thus in such circumstances along with the psychological counselling pharmacotherapy
becomes essential tool to withdraw from substance abuse and relapse events. Though
behavioural and cognitive therapies plays a dominating role in providing emotional support to
addicted people which helps them to manage their addiction. However during the process in
order to deal with the biological changes and relapse events it becomes necessary for the
professionals to prescribe drugs which have same impact on brain system as illicit drugs or
alcohol have.
7. Pharmacotherapy interventions
A vast range of pharmacotherapy could have been used for Winehouse so that her life
could have been saved. For instance the drugs such as buprenophine is considered as effective in
terms of treating opioid addiction. The alcohol addiction of Winehouse was so severe that it was
impossible for her to withdraw from it. Thus medication such as acamprosate, naltrexone and
disulfiram could have been provided to her so that her willingness to consume alcohol could
have been treated. These therapies are effective in terms of reducing craving as well as managing
the post withdrawal symptoms (Flanagan & et.al., 2016). The effectiveness of pharmacotherapy
can be increased by integrating them with the behavioural therapies.
The opioid substitution therapy (OST) is known as the harm minimising therapy in which
opioid addiction is controlled by prescribing patients similar medications such as buprenophine
or methadone which are swallowed and gives similar simulation to the brain. Winehouse was
also addicted to heroin and thus use of this therapy was highly recommended for her. This
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pharmacotherapy stabilises the opioid receptors in the brain which results in elimination of
craving and withdrawal symptoms (Brett & Murnion, 2015). These therapies are highly effective
for re-establishing well being and better functioning among drug addicted people.
8. Critical evaluation of interventions
The pharmacotherapy is very effective for the treatment of drug addiction. For the
recovery of patient detoxification or medically managed withdrawal is first stage in which drug
addiction is controlled by managing withdrawal symptoms. The pharmacotherapy interventions
control these symptoms so that detoxification symptoms does not cause any severe medical
consequences. For eliminating these consequences medications play effective role as they can
counterbalance these brain effects. Similarly for addressing the withdrawal and prevention of
craving fro drugs pharmacotherapy drugs acts as agents which produce similar neurological
effect as produced by illicit drugs (Lindblad & et.al., 2016). The similar effect produced by
these medications taper the agents in gradual process so that comfortable discontinuation can be
promoted.
Amy Winehouse also tried to overcome the alcohol addiction however the symptoms
such as sleep disturbances, indigestion, mood swings, restlessness and enervation were not
managed effectively and thus the popular singer failed in dealing with her addiction. Due to this
reason for the patients suffering from addiction or seeking treatment for substance abuse or
psychological disorders along with the behavioural therapies it is necessary that
pharmacotherapy is also provided to them.
The pharmacotherapy also address the craving or relapse situation by administering
agonist in the form of medications like methadone maintenance treatment which could have been
used for treating opioid disorder of Amy Winehouse. However there are certain harmful effects
of this therapies are must also taken into account. For instance Naltrexone which lowers the
craving for alcohol is effective in dealing with relapse events but it can lead to fluctuation in
plasma levels and adherence to regular treatment regimen (Jamison & Mao, 2015). Similarly
disulfiram has association with liver toxicity. However these adverse events can be managed if
addictions are controlled in short period with the support form behavioural therapies.
CONCLUSION
From the above case study it can be concluded that substance abuse have extremely
harmful impact upon physiology and mental well being. Thus individuals must understand the
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pharmacodynamic properties of these substances so that they can assist health care professionals
and rehabilitation service providers to provide complete care to addicts. It has been also analysed
from the above discussion that drug interactions also has certain benefits but if its usage is not
controlled and monitored then it can be life threatening. Hence it is recommended that
pharmacotherapy must also take emotional breakdown and patient centred approaches into
account. It will help to control the addiction habits and life threatening impact of drug abuse.
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REFERENCES
Books and Journals
Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and
dependence. Australian prescriber, 38(5), 152.
Cunill, R. & et.al., (2015). Pharmacological treatment of attention deficit hyperactivity disorder
with co-morbid drug dependence. Journal of psychopharmacology, 29(1), 15-23.
de Andrade, D. & et.al., (2018). Substance use and recidivism outcomes for prison-based drug
and alcohol interventions. Epidemiologic reviews, 40(1), 121-133.\
Fazel, S. & et.al., (2016). Mental health of prisoners: prevalence, adverse outcomes, and
interventions. The Lancet Psychiatry, 3(9), 871-881.
Flanagan, J. C. & et.al., (2016). Concurrent treatment of substance use and PTSD. Current
psychiatry reports, 18(8), 70.
Hagedorn, H. & et.al., (2018). Advancing pharmacological treatments for opioid use disorder
(ADaPT-OUD): protocol for testing a novel strategy to improve implementation of
medication-assisted treatment for veterans with opioid use disorders in low-performing
facilities. Addiction science & clinical practice, 13(1), 25.
Jamison, R. N., & Mao, J. (2015, July). Opioid analgesics. In Mayo Clinic Proceedings (Vol. 90,
No. 7, pp. 957-968). Elsevier.
Lindblad, R. & et.al., (2016). Mortality rates among substance use disorder participants in
clinical trials: pooled analysis of twenty-two clinical trials within the National Drug
Abuse Treatment Clinical Trials Network. Journal of substance abuse treatment, 70, 73-
80.
Pergolizzi, J. V. & et.al., (2017). The basic pharmacology of opioids informs the opioid
discourse about misuse and abuse: a review. Pain and therapy, 6(1), 1-16.
Rolland, B., & Naassila, M. (2017). Binge drinking: current diagnostic and therapeutic
issues. CNS drugs, 31(3), 181-186.
Sofuoglu, M., DeVito, E. E., & Carroll, K. M. (2018). Pharmacological and behavioral treatment
of opioid use disorder. Psychiatric Research and Clinical Practice, 1(1), 4-15.
Online
Topping,. A., (2013). Amy Winehouse died of alcohol poisoning, second inquest confirms.
[Online]. Accessed through <https://www.theguardian.com/music/2013/jan/08/amy-
winehouse-alcohol-poisoning-inquest>
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