GENERIC DRUGS

 





















 DRUGS

Drugs are organic or inorganic substances used as medicines directly or in the preparations of medicines or as narcotic .

 A medicine may be defined as a preparation used for curing disease under the guidance of qualified physician. 

 A narcotic is a drug or chemical which depresses the activities of central nervous system. 



Drug Abuse:

Drugs are normally  used as medicines to help patients cope with mental illness like depression, insomnia and so on. But when drugs are taken for a purpose other than their normal clinical use in an amount, concentration of frequency that impairs one's physical, physiological and psychological function, it constitutes drug abuse.The term " abuse" with respect to drugs concerns three aspects : 
(i) Non__ prescribed use,
(ii) Non_ medical use and 
(iii) Use for having pleasure. 




Drug Dependence  ( Drug Addiction) 

The term "drug dependence " is now _ a _ days preferred to " drug_ addiction " or " drug habituation" ( WHO,1964).
  
  Drug addiction  is defined as a state of periodic  or chronic intoxication detrimental to the individual  and society produced by the repeated intake of habit _ forming drugs.
 Addiction is defined as the habitual psychological and physiological dependence on a substance or practice which is beyond voluntary control.

Types of drug dependence:

It includes psychological dependence and physical (=  physiological) dependence.

(i) Psychological dependence : It develops when the individual believes that normal conditions of well being is achieved only through the actions of the drug.

(ii) Physical  dependence: (= Physiological dependence). It is a changed physiological state produced by repeated intake of a drug which become necessary to maintain physiological equilibrium. Discontinuation of the drug results in a characteristic withdrawal symptom. As the nervous system functions normally  in the presence of  the drug, the nervous system becomes adaptable to the drug, so it is called ' neuroadaptation', while the term ' dependence ' may be restricted to psychological dependence. 

(iii) Development of tolerance: There is a tendency  to increase the  dose.

Problem :

  Drug abuse has reached an alarming proportion in recent years. " Drug culture" is fast making inroads into the lives  of young  people from all walks of life. The reasons given for drug dependence include the following:

   _ curiosity and natural tendency to experiment with drugs

__ disturbed  home environment: children from broken homes, indifferent parents, lack of communication between parents  and children

__ an escape  phenomenon from tensions, and frustrations in life, e.g., unemployment, failure in examinations. 

__ impact of disco culture 

__ ignorance regarding the habit_ forming  nature of the drugs

__ lack  of  Communication: " generation gap".



A wide  range  of drugs 

The drugs  commonly used are : 

(a) Narcotics : _ e.g., opium, morphine, heroin and codein. Heroin is 200 times more potent than morphine,and is sold under various trade names such as " brown sugar", "  smack", etc. 

(b)  Hypnotic sedatives : e.g., Barbiturates. 

(c) Cannabis family :_ e.g., Hashish or  charas, ganja and bhang collectively known as marijuana.

(d) Hallucinating  drugs :_ e.g., LSD, mescalne .

(e)  Stimulants:_ e.g., cocaine and  amphetamines. 

(f) Tranquilizers:_ e.g.,equanil, chlorpromazine. 

(g) Tobacco. 
(h) Volatile solvents:_ e.g., glue, petrol, chloroforms, paint thinners etc.

   

Management 

Through drug addiction may be considered as social problem, the first step in its  management is medical care, which includes:

__ identification of drug addicts and  their motivation for detoxication  

_ detoxication  (requires hospitalization)

__ post _ detoxication counselling and follow_ up ( based on clinic  and home visits), and 

_ rehabilitation.

  

Simultaneously with medical  treatment, changes in environment (home, school,  college, social circle) are important. The patient must effect  a complete break  with his group, otherwise  the chances of relapse are 100 per cent. Psychotherapy has a valuable  place  in the management  of the addict.

  
 Preventive   measures include education of target groups  and the general publi through  TV, radio, leaflets,  and posters  to create awareness of the problem. The Government have promulgated an Act called the " Narcotics Drugs and Psychotropic Substances Act" which came into force in 1985 to combat this problem. 


GENERIC DRUGS : 

Recently, Ministry of Health and Family Welfare issued an alert to all the doctors in the Central Government Hospitals/ Central Government Health Scheme (CGHS) Wellness Centres / Polyclinics to prescribe generic medicines only.A generic Medicine/drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. It works in the same way and provides the same clinical benefit as the brand-name medicine.    
   


                                                                                           
 Presently, there is no definition of generic or branded medicines under the Drugs & Cosmetics Act, 1940 and Rules, 1945.  Regulation of Generic Medicines in India. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 by Medical Council of India: It prescribes that every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drug.  National Medical Commission Act, 2019 by Ministry of Health and Family Welfare: Empowers the appropriate State Medical Councils or Ethics and Medical Registration Board (EMRB) of the Commission, to take disciplinary action against a doctor for violation of the provision of the aforesaid Regulations.  Drugs and Cosmetics Rules, 1945 amendment by Ministry of Health and Family Welfare: For making it mandatory to grant license for a drug formulation containing single active ingredient in proper name only.  Drugs Technical Advisory Board of India (DTAB): It allows pharmacies to sell generic medicines to patients even if the prescriptions specify the branded versions. ✓ DTAB is the highest decision-making body under the Ministry of Health and Family Welfare on technical matters related to drugs.


Types of ADDICTIVE DRUGS ( HABITUATING DRUGS) 

The habituating drugs are grouped  into two main categories psychotropic drugs and psychedelic drugs. 

A. PSYCHOTROPIC DRUGS:

These drugs affect the mental process of the person. They either induce sleep or produce calming effect and alter behaviors, consciousness and capacity of perception and hence called MOOD ALTERING DRUGS. The repeated use of these drugs make the body dependent on them. Psychotropic drugs are further divides as follows : 

1) Tranquilizers:

The decrease tension and anxiety and produce a feeling of calmness. 

(i) Antipsychotic Drugs (Major Tranquilizers) : These drugs have good effect in all types of psychosis, specially schizophrenia. In a psychotic patient, these drugs reduce aggressiveness. Thought and behaviour are gradually normalised and anxiety is relieved. Examples of Antipsychotic drugs are phenothiazines, Butyrophenones, Pimozide, Reserpine, etc.

(ii) Antianxiety Drugs (Minor Tranquilizers) : These drugs are used for anxiety and phobic conditions. Benzodiazepines (BZDs) are main antianxiety drugs. 
Examples : (i) Hipnotic ,e.g., Diazepam, Flurazepam, Nitrazepam, Temazepam, Triazolam and Midazolam 

(ii) Antianxiety , e.g., Diazepam, Chlor_ diazepoxide, Oxazepam, Lorazepam, and Alprazolam 

(iii) Anticonvulsant, e.g., Diazepam and Clonazepam. BZDs hasten sleep, reduce intermittent awakening and increase total time. They produce skeletal muscle relaxation  without disturbing voluntary activity. 
 
 Benzodiazepine is drug of choice in alcohol withdrawal symptoms. 


2) Sedative and  hypnotics :

Sedative is a drug that reduce excitement, assuage pain and lowers the physiological or functional activity leading  to drowsiness  or sleep .Hypnotic is also a drug that induces sleep. Sedative and hypnotics are more or less general CNS depressants .Sedative and hypnotics include Barbiturates and Benzodiazepines. 

  (i) Barbiturates are substituted derivatives of barbituric acid ( a combination of melonic acid and urea called malonly   urea). Barbiturates are general depressants for all excitable cells but the CNS is most sensitive  o these drugs. These are taken to reduce anxiety  and induce sleep. Addiction occurs  through repeated use of these drugs. It results in permanent damage to brain, headache, muscular twitching and coma. Sudden withdrawal causes epilepsy. Barbiturates may be divided into three categories. 

(a)  Barbiturates having very  short action ( under three  hours) are Thiopentone, Hexobarbitone and Methohexitone .

(b) Barbiturates having  short action (3_ 6 hours) are Butobarbitone, Secobarbitone and Pentobarbitone.

(c) Barbiturates having long action ( 6 or more hours) are Phenobarbitone and Mephobarbitone.Barbiturates when taken alongwith alcohol, cause dramatically  increased depressant effect.

(iii) Benzodiazepines have already been described under the heading Antianxiety Drugs.

3) Opiate / Opioids Narcotics :

The drugs derived from opium alongwith their synthetic relatives are called opioids or opiates narcotics. The drug that relieves pain by acting on the CNS is termed as analgesic. Opioids bind to specific opioid receptors present in our central nervous system and gastro intestinal tract. They are also called pain killers. Opium is dried latex of unripe capsular fruits of poppy plant, Papaver Somniferum ( family  Papaveraceae) .It is reddish _ brown in colour. It has heavy smell and bitter taste. It is eaten or smoked. Opiates have narcotic, analgesic, astringent ( that causes contraction of body parts), and sedative effects. They slow down respiratory activity, causes constriction of  pupil of eye, decrease glandular  secretions, impair the digestion, produce nausea, vomiting and  sterility. The opium addict loses, weight, fertility and interest in work. Opium contains a number of alkaloids.





(i) Morphine : Serturner,a pharmacist, isolated the active principal of opium in 1806 and named it 'morphine' after the Greek god of dream Morpheus .It is the principal opium alkaloid. It is a strong analgesic.It also has sedative and calming effect.The person lacks initiative and is unable to concentrate. Morphine depresses respiratory centre.It contributes to the fall in BP. It can cause bradycardia (slow heat beat). Morphine can release ADH and reduce urine output. Constipation is a prominent feature of morphine action. Morphine causes mild hyperglycaemia.It causes addiction. Diacetylmorphine hydrochloride is brown sugar/ smack and is more powerful analgesic than morphine. Morphine is a very effective sedative and painkiller. It is very useful  in patients who have undergone surgery. 

(ii)  Codeine : It is also a derivative of opium. Infact it is methyl__ morphine  which occurs naturally in opium and is partly converted in the body to morphine. It is mild analgesic.It does not cause addiction. It is an ingredient of many medicines and cough syrups. Its Prominent side effect is constipation. 

(iii) Heroin : ( Diamorphine or Diacetylmorphine __ C17H17 (OC2 H3O)2 ON, also called H, smack).It is semisynthetic opiate which is most dangerous of all the opiates. It is about 3 times more potent than morphine.Because of its  high  potency, it has been favoured in illicit drug trafficking. Hence it has  been banned in most countries. Heroin is formed from morphine by acetylation.It is highly addictive and, therefore, considered most dangerous opiate. Heroin is taken orally, or inhaled or injected. Pure drug is seldom taken. It induces drowsiness and lethargy. Its after effects include indigestion, reduced vision, decreased weight, sterility and total loss of interest in work. As the heroin addicts are careless about syringes  and needles for injection so this may cause blood poisoning  abscess formation, hepatitis _B and AIDS. Withdrawal symptoms are unpleasant which include vomiting, diarrhea, shivering, running nose, muscular and abdominal cramps and epilepsy. 

(iv) Smack : It is a crude by__ product of heroin synthesis. It is commonly called " Brown Sugar" because smack is cheap, it is considered " poor man's  heroin". The addicts heat the smack power and inhale its  vapour. Smack is diacetvlmorphine hydrochloride. It is stronger analgesic than morphine.

(v) Pethidine ( Mederidine) : It is a synthetic  opiate .Although it is chemically unrelated to morphine yet it has many similar actions. Its  analgesic efficiency is near to morphine and is more than codeine. It is equally  sedative and euphoriant. It causes less histamine release and is safer in asthmatics. It has local anaesthetic action. It is mostly metabolized  in liver.

(vi) Methadone :  It is also a synthetic  option which is chemically dissimilar  but pharmacologically is very similar to morphine. It has analgesic, respiratory depressant, constipating actions similar to morphine. Withdrawal symptoms are gradual and less severe. 

4) Stimulants :

These drugs stimulate the nervous system; make a person more wakeful, alert and active; and cause excitement. However, addiction is psychological and withdrawal of stimulatant is followed by depression, anxiety and restlessness. The principal stimulants are caffeine, cocaine and amphetamines. 

(i) Caffeine :  Chemically , caffeine is 1,3,7  Trjmethylxanthine.It is a white crystalline bitter alkaloid obtained from the leaves of teaplant, Thea sinensis __ a shrub, seeds of coffee plant, Coffea arabica__ a shrub, seeds of cocoa plant, Theobroma cacao __ a tree yielding cocoa and chocolate. It is a mild stimulant and taken  as beverages __ tea, coffee, cocoa and cola drinks.Caffeine is CNS stimulant.It provides a sense of wellbeing, alertness, beats boredom, thinking becomes clear, improves performance. It acts as cardiac and respiratory stimulant. It is a mild diuretic ( increases urine output). Caffeine increases contractile power of skeletal muscles. It increases BMR ( Basal Metabolic  Rate). It inhibits the release of histamine. Higher doses of caffeine cause nervousness, restlessness, panic, insomnia, ( lack of sleep) and excitment. Excessive  intake of caffeine  also causes addiction and indigestion and disturbs renal functions. 





(ii) Cocaine : It is natural coca alkaloid obtained from leaves of coca (= cocca) plant __ Erythroxylon coca (family Erythroxylaceae)__ a South American plant growing on the foot hills of Andes. Cocaine is commonly called coke or crack.It is bitter, white, crystalline power and called snow, sniff, crack, coke, princess, Big C. Cocaine has vasoconstrictor properties and therefore, is a good local anaesthetic. It is taken by snorting. It is a powerful CNS stimulant.It induces a sense of wellbeing and pleasure and delays fatigue.It increases heart beat, blood pressure and body temperature. It  is smoked or injected or inhaled by addicts. It causes lack of sleep and loss of appetite. Its overdoses cause headache, convulsions, insomnia, respiratory or cardiac failure and may lead to mental disorder. Excessive dosage of cocaine causes hallucinations. Some other plants such as Atropa belladona and Datura have hallucinogenic properties. 

(iii) Amphetamines [a(lpha) + m(ethyl) + ph (enyl) + et (hyl) + amine __ Alpha methyl  phenyl amines ; C6H5 CH2 CH ( NH2) CH3].They are synthesis drugs. They are commonly called pep pills or anti sleep drugs as they are CNS stimulants.They causes alertness, self __ confidence, talkativeness and increased work capacity. They stimulate respiratory centre. They cause wakefulness and postponement of sleep and hence called antisleep drugs. Since metabolism of amphetamines is slow, the drug is found in the urine for several subsequent days. Amphetamine is one of the drugs include in the ' dope test' for athletes. They  do not remove fatigue. They suppress hunger ( anorexia) and cause addiction. High doses of amphetamines produce euphoria, (sense of well being) marked excitement, sleeplessness which may progress mental confusion. After  effects include nausea and vomiting. 





B) PSYCHEDELIC DRUGS (= HALLUCINOGENS) 

These drugs change one's mood,behaviour, thoughts and perceptions in a manner similar to that seen in psychosis. The hallucinogens, in general produce  a dream_ like state with the disorientation and loss of contact with reality. These include chemicals such as LSD ( Lysergic acid diethylamide), Mescaline, Psilocybin and products of hemp plant. Cocaine and amphetamines are also capable of producing  hallucinations. 




1) LSD ( Lysergic acid diethylamide :

It is the most powerful psychedelic (=hallucinogen).Its chemical formula is C15H15N2CON (C2H5)2.It is a crystalline aminated alkaloid obtained from ergot,an extract got from fruiting body of fungus Claviceps purpurea that is parasite on Rye plant.It is always smoked.LSD was synthesized by Hofman ( 1938). LSD causes horrible dreams, emotional outbursts, hallucination, chronic psychosis and severe damage to the central nervous system.It also brings about chromosomal and foetal abnormalities. An  LSD addict can be easily  recognised from incoherence in writing and drawing. 

2) Mescaline :

It is a white powderly alkaloid, obtained from the tops (called mescals) of a  small spineless cactus, Lophophora Willliamsii, native to the SW United States and Northern Mexico. This cactus is also called ' Peyote cactus'.Its chemical formula is C11H17NO3. It is a low potency halluinogen.

3) Psilocybin :

It is obtained from the fruiting bodies of Mexican mushroom ( fungus). Psilocybe Mexicana (Family Agaricaceae).  Its chemical formula is C13H18O3N2P2. Psilocybin is a crystalline solid that may have value in psychological medicine. Its effects are similar to those of masculine. 

4) PCP ( Phencyclidine Piperidine):

It is widely used in veterinary medicine to briefly immobilize large animals. PCP is available to addicts as angel  dust (while granular powder). It has stimulant, depressant, hallucinogenic and analgestic properties. Higher does of PCP may produce hypersalivation, vomiting, fever and even coma.

A number of other synthetic derivatives like DMT (Dimethyltrytamine), DOM(Dimeth__     oxymethylamphetamine), DMA ( Dimeth__    oxyamphetamine) are also hallucinogenic.

5) Cannabinoids ( Products of Hemp Plants) :

They are group of chemical which interact with cannabinoid receptors present mainly in the brain. Natural cannabinoids are  obtained from the inflorescences of hemp plant Cannabis sativa, family cannabinaceae.The flower tops, leaves and resin of Cannabis plant are used in various combinations to produce bhang, ganja, charas  and marjuana. These drugs are generally taken by inhalation and oral ingestion .They affect the cardiovascular system of the body.

Poisoning of cannabis preparations is called cannabism (G. Kannabis = hemp).

(a) Bhang : It is fresh/ dried leaves and flowering shoots of both and female plants of Cannabis sativa (Family Cannabinaceae).  Bhang is generally taken  orally (e.g., drink or in the form of pakora or tikki). It acts slowly.

(b) Ganja : It the dried unfertilized female inflorescence of Cannabis sativa. It is smoked generally  in cigarettes. It is more potent. It effects are produced  almost instantaneously. 

(c) Charas : It is the dried  resinous extract from the flowering tops and leaves of Cannabis sativa. It is most potent and smoked  with tobacco. In some countries like America,  charas is called hashish.Liquid hashish is called hash oil, which may contain a THC concentration of 25 to 60 per cent.

(d)Marijuana  : This is obtained from the dried flowers and top leaves  of the female plants of Cannabis sativa. The most active ingredient of marijuana is delta _9 tetrahydrocannabinol ( Delta __ 9 THC).It is smoked in cigarettes. A typical marijuana cigarette contains 0.5 to 1g of plant material. Although the usual THC concentration varies between 5 and 20 mg, concentration as high as 100 mg  per cigarette has been detected. Marijuana may cause psychosis. 

  Products of Hemo plants raise the blood sugar level and increase the frequency of urination. They are relatively less harmful but regular intake of these products may lead to heroin  like addiction. They bring about a state of well being ( euphoria), excitement, sometimes uncontrolled laughter and dilation of pupil of eyes. They are very harmful if taken alongwith alcohol causing decreases coordination, increased reaction time and impaired judgment. These days cannabinoids are also being abused by some sports persons.

6) Dature and  Belladona :

Seeds of Datura stramonium and parts of Atropa belladona are misused for their hallucinogenic properties. They are fatal even in slightly excess amount.





Drugs as a Social Stigma:

When the use of drugs  deviates  from the approved medical and social patterns, it is called social stigma (sign of  disgrace). The drugs are used by self medication without the approval of proper medical authority and social patterns in a given culture at a given time. It is a social disapproval of the manner and purpose of drug use.

  The drug addicts are not liked by colleagues, friends and even family members. They are socially boycotted. People also avoid  mixing with drug addicts. They lead a dull  and  unhappy married life. They deprive their family members of basic needs and create many types of domestic problems. Frustation and  insecurity in children are a heavy price to pay for drug addiction. Their children may become antisocial. Unmarried drug addicts have less chances of marriages. Such people are also not successful  in business  because they are not trustworthy. 

Common Drugs Causing addiction:

(i) Sleeping tablets ( Phenobarbitone __ a Barbiturate).

(ii) Antianxiety drugs___ Diazepam ( Calmpose), Alprazolam ( Alprax), Chlordiazepoxide ( Librium). All these drugs are Benzodiazepines. 

(iii) Strong pain killers __ Fortwin, Pathedine, Morphine. 

(iv) Cough  mixture containing Codeine ( Corex, Phensedyl, etc.)  Codeine  is a opiate. 
 
(v) Opium in various forms, 

(vi) Cannabis __ Bhang, Ganja and Charas.

(vii) LSD.

(viii) Smack __ It is commonly  called as " Brown Sugar". When Heroin is prepared  from opium, the crude and  cheap form of heroin is called smack.


How Drug Addiction Starts?

There are several reasons causing drug addiction. 

1) Curiosity: Frequent reference to drugs in newspapers, literature and on radio makes a person curious to have personal experience of the taste of a particular drug.

2) Peer group  pressure: Constant description by friends about the " good feeling " creates a temptation. Such inspiration from friends and peer groups acts as a pressure to start with drugs. 

3) To overcome frustrations and depressions: The desire to get solace or relief from personal problems initiates the use of drugs. The school children who take refuge  in drugs are usually lonely, unloved and insecure. 

4) Apathy : The lack of interest in day _ to __ day activities of an individual may lead to drug addiction. 

5) Excitement and adventure: It is natural for the young to look for some exciting work.
The intake of drug being illegal satisfies that feeling of excitement and adventure. 

6) Looking  for a different  world: Some people believe that drugs open up a new world of perception. It increases  the ability to appreciate the aesthetic beauties, helps in intellectual enlightenment and creativity. 

7) Desire to do more physical or mental work :Some people use  drugs to increase  their working power. 

8) Persistent use to get relief from pain : People  suffering from pain often take drugs for relief . This practice  makes them addicts.

9) Availability of the drugs : Availability of some drugs has been increased by medical over __ prescribing. There has also been a relative decline  in price of these drugs. 

10) Family history  : Examples if parents or members of the family using drugs act as the most natural stimulant. 

Symptoms of drug addicts :

These included  irritation, under excitement, unprovoked violence, frequent mood changes, sleep disturbance, drowsy looks, pale looking eyes, loss of interest in work and studies, socially  inactive, increased demands of money, staining of teeth because of smack use, poor memory and concentration, unexplained loss of weight and poor appetite, may look inattentive and lost, looks weak and exhausted, concerned person may spend too much time in toilet or bathroom, his or her valuables get frequently stolen and gets up  late in the morning. 

De __ Addiction :

Treatment  of the drug addiction is called de_ addiction. Psychiatrists are specifically trained to treat drug addicts. In some cities there are special centres for treating these patients. Some  addicts are treated  as outdoor patients, however, in some cases a 10__ 15 day admission is required. Addicts also  need regular counselling. A close vigil should be necessary on the patient because mental confusion may occur any time during the treatment. Although proper medicines are given to the patient, yet the treatment is combined with supportive measures such as vitamin administration, restoration of electrolyte balance and proper hydration. 

 It  is believed that when an addict is he drug, the level of chemical called C__ amp in the brain shoots up and the result is withdrawal symptoms. But vitamin C prevents the C_ amp from rising thus averts the withdrawal symptoms. An Ayurvedic herb combined with multiple  vitamins is used to cure drug addiction, because  drugs, primarily,  burn the vitamins causing many physiological disorders. 

 The use of acupuncture in the treatment  of drug addiction  is in practice  in China and in some other countries. Role of the family  members of  the addict is also very important. 

Drug withdrawal symptoms :

Withdrawal  symptoms are physical and psychological disturbances which appear in an addict when they do not take the needed dosages of drug, alcohol or tobacco. They vary with the type and degree of addiction. 

(a) There is no physical  and physiological dependence on stimulants (e.g., amphetamines, caffeine), therefore, there are  no physical withdrawal symptoms. The dependence is only psychological which is exhibited  by restlessness, anxiety and depression. 

(b) Withdrawal  symptoms of opiates produce cramps, vomiting  running nose and epilepsy. Withdrawal symptoms of Heroin are unpleasant. They include vomiting, nausea, diarrhea, twitching, shievering, perspiration and muscular cramps. 

(c) Sudden withdrawal  of Barbiturates cause epilepsy. 

Some examples  of drug withdrawal reactions  are given below :

(i) Severe  hypertension ( high blood pressure)  and sympathetic over overactivity
(over action of sympathetic nervous system) may occur just after discontinuing Clonidine.

(ii) Acute adrenal deficiency may occur due to sudden stoppage of corticosteroid treatment. 

(iii)  Frequency of seizures  may increase by abrupt  withdrawal of an antiepileptic. 

(iv) Worsening  of anginapectoris ( a heart disease) may result from stoppage of B_ blockers .

These conditions can be minimized by gradual withdrawal of the drugs. 

Combinations  of Drugs : Some  drug addicts use mixtures  of drugs to have immediate  effect. Some of these combinations and their effects are given below.





Effect of Drug Addiction  on Family, Society  and Addicts:

The drug _ users not only themselves suffer from the ill_ effects of drug addiction,  they also bring miseries to the entire family. 

 Since they get the supply  of the drugs from__ illegal  source, they encourage smuggling and other associated illegal ' activities,  resulting in several other social problems. 

 Prolonged use of drugs leads to nervousness and psychosis. They neglect their studies, duty and bring frustration not only for themselves but also for their family and community. 
  
 It is evident that all the drugs affect the  central  nervous  system and their prolonged use causes permanent damage. The body fails to work without the drugs. Ultimately other  organs also get damaged, and the drug__ users become victims of various diseases. Many drug addicts inject these drugs in their blood vessels with previously used needles. Studies have shown that AIDS and Hepatitis __ B are common in addicts using intravenous drugs.

  Continuous use of narcotis and stimulants cause impotency and chromosomal aberrations and production of abnormal babies. 

Precautions in use of Drugs

Drugs are used for diagnosis, prevention, treatment and cure of  a  disease, but indiscriminate use of drugs can cause adverse effects. One should take the following  precautions while using the drugs.

(i) Do not use drugs without consulting a qualified doctor. 

(ii) Remember that many " doctors" who claim to have miracle cure, infact they mislead the patients. 

(iii) Do not take medicines from unknown persons. 

(iv)  Don't  consider the chemists as ' doctors ' and donot allow them to change the medicines. 

(v) Complete the course  as suggested by the doctor. 

(vi)  In case of any adverse effect  during treatment, the drug should be withdrawn. 

(vii) Some drugs such as steroids should not be taken on an empty stomach. 


(viii) Aspirin is a commonly used medicine, but its excessive  use causes gastric mucosal damage and peptic ulceration. 

(ix) Prolonged use of certain  medicines may aggravate some diseases. For example, prolonged glycocorticoid therapy may aggregate diabetes mellitus. 

(x) It is better to avoid drugs pregnancy unless their use is considered very  essential. 

Status of Pharmaceutical in India 

●The Pharmaceutical industry in India is the 3rd largest in the world in terms of volume and 14th largest in terms of value. 

 ●India is the largest provider of generic medicines globally, occupying a 20% share in global supply by volume.
 ● Economic Survey 2022-23 estimated India’s domestic pharmaceutical market to touch $130 billion by 2030.



Initiatives to promote Generic Medicines

 ● Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in 2008 by Ministry of Chemicals and Fertilizers: Under which PMBJP Kendras across the country will make quality generic drugs and implants accessible at affordable prices.

 ● National Health Mission (NHM) in 2008 by Ministry of Health & Family Welfare: Support is provided for provision of essential generic drugs free of cost in public health facilities. 

●Production Linked Incentive (PLI) Scheme by Ministry of Chemicals and Fertilizers: PLI Scheme for Promotion of Domestic Manufacturing of critical Key Starting Materials (KSMs)/ Drug Intermediates and Active Pharmaceutical Ingredients (APIs). 

Reasons for promoting Generic Medicines 

Improve medicine affordability:Generic medicines cost less than brand-name medicines and have the same therapeutic effect. 

 ■ As per Economic Survey 2022-23, about 48.2% (201819) of total health expenditure in India is financed by household out-of-pocket expenditure.

 ■ Medicines constitute 20% to 60% of total healthcare expenditure.
 
 ● Creates competition: Multiple generic drugs are often approved for the same single product; this creates competition in the marketplace, typically create more options.

 ● Expanding geriatric population and rising comorbidities: It helps in improving the accessibility and availability of critical medicines.

 ● Developing pharmaceuticals sector: Under Make in India initiatives government promoting pharmaceuticals sector and generic medicine provide the opportunity for the same. 

Expanding Generic medicine export market: Currently, India supplies over 50% of Africa’s requirement for generics, ~40% of generic demand in the US and ~25% of all medicine in the UK. 


Challenges in promoting Generic Medicines 

● Illegitimate drugs: In 2018, the Central Drug Standard Control Organization (CDSCO) identified nearly 4.5% of all generic drugs circulated in the domestic market to be substandard.

 ● Lack of quality testing facilities: Drug control procedures in India suffer from the lack of fund, resources, and manpower. 
● Counterfeit medicines sellers: They operate at the retail level and procure the substandard medicines from dubious suppliers. 
 ●Perception of Patient: There is negative perception in the patient that the quality of the medicine directly depends on the cost of it. 
●Ever-greening of Patents: Big pharmacy companies maintain their monopoly on drug and revenue by doing minor reformulations or other iterations of the drug, without necessarily increasing the therapeutic efficacy. 
■ In India (under Indian Patent Act, 1970), patents are granted for a maximum term of 20 years only. 
● Import dependency for Key Starting Materials (KSMs)/Active pharmaceutical ingredients (API): India is heavily dependent on other countries for active pharmaceutical ingredients (API) and other intermediates. Example-around 70-80% of the APIs are imported from China. 
●KSMs-A raw material, intermediate or an API that is used in the production of an API and that is incorporated as a significant structural fragment into the structure of the API.
 ■ API-Any substance or mixture of substance intended to be used in the manufacturing of a drug(medicinal) product and that, when used in the production of a drug, become an active ingredient of the drug product.

What is an example of a genetic drug?


An example of a generic drug is "Ibuprofen." Ibuprofen is a widely used nonsteroidal anti-inflammatory drug (NSAID) that is available under numerous brand names but also as a generic medication. The generic version is chemically equivalent to the brand-name product but is typically marketed at a lower cost. Generic drugs undergo rigorous testing to ensure their quality, safety, and efficacy, and they can provide a more affordable alternative to brand-name medications.

Are generic drugs less effective? 


Generic drugs are required by regulatory authorities to have the same active ingredients, dosage form, strength, route of administration, and intended use as their brand-name counterparts. This means that, by definition, generic drugs should work in the same way as brand-name drugs.

However, several factors may lead to the perception that a generic drug is not working as effectively as a brand-name drug:

1): Bioequivalence: Generic drugs are required to demonstrate bioequivalence, meaning they are expected to be absorbed into the bloodstream at a similar rate and to the same extent as the brand-name drug. While small differences in absorption rates are allowed, these differences are not expected to have a significant impact on clinical effect.

2): Individual  Variation: Different individuals may respond differently to medications due to factors such as genetics, age, weight, metabolism, and underlying health conditions. This individual variation can affect the perceived effectiveness of a particular drug, whether it is generic or brand-name.

 3): Expectations and Perception: The expectations and perception of a medication's effectiveness can influence the individual's response. If a person has a preconceived notion that generic drugs are less effective, they may attribute any perceived differences to the drug being generic when it may not actually be the case.

It is important to note that generic drugs undergo rigorous testing and regulatory approval processes to ensure their safety, quality, and effectiveness. They must meet the same quality standards as brand-name drugs. If a generic drug is approved by regulatory authorities, it is expected to work as effectively as the brand-name drug it is based on.

 RESPIRATORY SYNCYTIAL VIRUS (RSV) 

• US Food and Drug Administration has approved GSK’s Arexvy, world’s first RSV vaccine for older adults. • Human RSV is a globally prevalent cause of lower respiratory tract infection in all age groups.  o In infants and young children, first infection may cause severe bronchiolitis that can sometimes be fatal. o RSV is increasingly being recognized as an important pathogen in older adults. • RSV belongs to the genus Orthopneumovirus within the family Pneumoviridae and order Mononegavirales.  o Members of this genus include human RSV, bovine RSV and murine pneumonia virus. 

Way Forward

 ● All Stakeholder approach: Drugs Controller General of India (DCGI) should work in close association with the pharmaceutical companies and local drug control authorities to control illegitimate drugs from market. 

●Clear categorization: DCGI must state clearly whether the drug is of poor quality or is it a counterfeit drug. This can help to great extent address the issue of fake drugs. 

● Use of New Technology: Anti-counterfeiting technology can assist with product authentication, tamper-resistant packaging and track and trace technology. 

● Awareness about Generic drugs: Use Information and Communication Technology for awareness generation among the patient about the drugs and Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) Kendras. 

● Strong Regulatory Framework: India needs a strong regulatory framework that not only ensures people in the country have access to quality generic drugs but also promises the inflow of innovative drugs and medicines from across the world.  

●Providing Compulsory licensing: Right to access of generic drugs is a human right and not granting compulsory licensing to such drugs would lead to restricting their production and access. 

■ Compulsory licensing is when a government allows someone else to produce a patented product or process without the consent of the patent owner or plans to use the patent-protected invention itself.  

■It is one of the flexibilities in the field of patent protection included in the WTO’s agreement on intellectual property — the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement. 

● Realigning Production Linked Incentives (PLI) for pharmaceuticals in 2021: As the products covered under this scheme, the import dependence is already quite low. 

■Also, the cost of domestic production of these APIs becomes many times more than that of the cost of imports.

Alcohol Abuse:

The word alcohol refers to ethyl alcohol or ethanol ( C2H5OH). Alcohol is manufactured by fermentation of sugars. 
 
                    Zymase
C6H12O6________2CO2 + 2C2H5OH
                 (in yeast)

 Industrial alcohol  is obtained by fermentation of starchy grains by the yeast _
Saccharomyces cerevisiae.Fermentation proceeds till  alcohol  content reaches 15% .After this, the reaction is inhibited by alcohol itself. starchy cereals like barley,  when soaked produce malt.

                     Convertas
 Starch       ➡️➡️➡️➡️  Maltose 

 Maltose can be fermented by yeast to produce alcohol. The major source of commercial alcohol is molases, a byproduct of sugar industry. 

 Alcohol  is normally used in the preparation of some medicines (e.g.,Syrups, etc), in the laboratories for testing of some materials. Even in cold countries drinking of small amount of alcohol is not harmful. But when drinking of excessive alcohol is done that impairs one's physical, physiological and psychological function. It constitutes alcohol abuse.

The dependence or addiction of alcohol is called alcoholism and the addict is termed as alcoholic. WHO declared in  1964 that alcoholism is a disease. 

Some of the commonly  used beverages, their source and alcohol content are tabulated below.

Alcohol abuse 

Alcoholism is a worldwide social and medical problem.Over the past 30 to 40 years, alcohol consumption has increased in quantity and frequency. The age at which people start drinking has also declined. The population groups at great risk are those undergoing rapid socio_ economic and cultural changes; they view alcoho  as  a symbol of prestige and social status.

Consequences: Alcohol harms the human body in many ways. By its action on the brain, it interferes with the faculties of perception, understanding and reasoning; by its action on the stomach, it causes gastritis; by its action on  the liver, it causes cirrhosis of liver ; by its action on the heart, it may cause hypertension and heart failure; by its action on the kidneys, it may cause albuminurea and other urinary  disorders. Over  indulgence may end up also do serious  prenatal and post_ natal damage  to the foetus. The consequences of alcohol abuse cover a wide spectrum: crime, murder, prostitution, neglect of families,  malnutrition, disease, unemployment, indebtedness, child delinquency, road accidents, loss  of friends and  self __esteem. In short excessive alcohol results serious  medical, psychological and sociological problems. 

 Drinking  by adults serves as a role model for the young. The identification of risk factors is essential for prevention. As drinking patterns very consistently, the prevention of alcoholism is not easy. A widespread public education and discussion, and investigation of public attitudes may result in measurable improvement. This should be combined with social welfare and health services. 

Why do people Start Taking Alcohol?

Research studies have  revealed that the people who resort to drinking offer one or more of the following reasons: 
(1) Social pressure, 

2)  Feeling  of independence, 

3) Liking of the taste, 

4) Desire of  excitement, 

5) Desire to escape  from such realities of life as disappointment and failures, and 

6) Hardships and monotony of everyday life.

Absorption of Alcohol (= Ethanol) :

Alcohol is absorbed from mucous and oesophagus (in   very small amounts), and from the stomach, from the proximal portion of the small intestine ( the major site) and large intestine (in modest amounts). The rate of alcohol  absorption from  stomach is dependent on its concentration, presence of food and other factors. 

Metabolism of Absorbed Alcohol:

Alcohol  gets distributed widely in the body, crosses blood barrier efficiently. It also crosses placenta freely. Some amount of ethanol is excreted directly through the lungs, urine or sweat, but the greater part is metabolized to acetaldehyde in the liver. Acetaldehyde is oxidised to acetate. The specific significance of acetaldehyde is not fully known, but its low levels may cause stimulation and behavioral reinforcement. Accumulation of higher levels, brain or other body tissues may cause organ damage. 


Is  Alcohol a Stimulant?

Many people  think that alcohol is a stimulant. But alcohol is not a stimulant. Actually alcohol acts as sedative ( lessens functional activity), analgesic ( relieves pain) and anaesthetic (causes loss of sensation).

Problems caused  by Alcohol:

Three types of problems are caused by alcohol drinking. 

(i) Social Problems: These include absence from work, unemployment, marital (marriage) tension, child abuse, financial difficulties and problems with law, including  violence and  traffic offenses. 

(ii) Psychological Problems : Heavy drinking  causes depression. Suicide attempt is much commoner in alcoholics than in the rest of society. Sexual relationships is usually deteriorated because of impotence or rejection by the partner.

(iii) Physical Problems: These are variable and can affect virtually any organ in the body.

Effects of Alcohol  :

It has been proved that the intake of   alcohol affects individual health, family life  and ultimately creates several community and social  problems. 

A) Effects on Individual Health:

Alcohol  generates a large amount of energy in the form of heat on oxidation. This heat is quickly lost through skin  causing flushing of the face and other body parts. The heat so released is of no use to body rather the body consumes its own energy for getting rid of this heat.Therefore, it  is wrongly interpreted to be stimulant .Rather it is a depressant  of nervous system and acts as sedative and reduces the efficiency of body organs by reducing  blood supply. 

 1) Local actions : Alcohol is an astringent ( causes contraction of body parts). By precipitating bacterial proteins it acts as a antiseptic.

2) Nutritional Factors : Deficiency of nutrients such as minerals proteins and vitamins are found in alcoholics. Low blood potassium, magnesium, calcium, zinc and phosphorus can occur in alcoholic. Vitamins like thiamine (B1), nicotinic acid (B3), pyridoxine ( B6), folic  acid,  ascorbic  acid ( vitamin C) and Vitamin A may be deficient in alcoholics. Thiamine( B1) deficiency causes Wetnicke's and Korsakoff's syndrome. Wernicke'syndrome  ( = Wernicke' disease or encephalopathy) is characterized by mental disturbance, paralysis of eye movements and ataxia (a loss of the power of muscular co_ ordination) of  gait ( manner  of or carriage in walking). Korasakoff's  syndrome ( = Korsakoff's  psychosis ) is characterised by confusion and severe impairment of memory, especially for recent events. 

3) Effect on immunity:Chronic alcoholics neglect their health and soon the body loses  its resistance against infections. 

4) Central Nervous System ( CNS) : Alcohol  is depressant to the brain. Even after only a few drinks, alcohol decreases sleep and depresses rapid eye movement ( REM). The overall effect is likely  to be repeated awakening and a sense of restless sleep.

In alcoholism cerebrum is affected first (person loses judgment, self control and will power) followed by cerebellum ( coordination of muscles is lost). This results in double and blurred vision, slurring of speech, loss of consciousness and inability to judge distances. 

5) Cardio Vascular System (CVS) : 

(i) Small doses dilate the blood vessels of skin ( specially  of  the face) and stomach. Blood pressure is not affected. 

(ii) Moderate doses cause direct myocardial and vasomotor centre  depression and there is fall in blood pressure. 

 Chronic  alcoholism may lead to cardiomyopathy the disease of myocardium.

6) Blood : Regular intake of small to moderate amounts has been found to raise HDL __high density lipoproteins ( good  cholesterol) and lower LDL __ low density  lipoproteins ( bad cholesterol) levels in the blood plasma. Alcohol  also reduces  blood sugar level which is harmful  to the functioning of brain.

7) Body temperature: Alcohol  produces a sense of warmth  due to dilation of blood vessels of skin and stomach.The alcohol combats cold. But high  doses of  alcohol  depress temperature regulating centre.

8) Gastrointestinal Tract ( GIT) : Dilute alcohol ( optimum 10%) stimulates gastric secretion ( specially acid ). Acute alcoholic intake  can result in inflammation of the oesophagus ( oesophagitis) and stomach (gastritis).Chronic heavy drinking,  if associated with violent vomiting, can  produce  a  longitudinal tear in the mucosa at the gastrointestinal junction __ a Mallory __ Weiss Syndrome  ( also called Mallory _ Weiss lesion).

9) Liver : Absorbed  alcohol is carried directly to the liver, where it becomes the preferred fuel. Use of moderate amounts of alcohol does not cause liver damage, provided adequate nutrition is maintained. However, chronic alcoholism causes the following diseases. 


(i) Alcoholic fatty liver : The liver becomes enlarged, yellow, greasy and firm. It increases the fat synthesis in the liver. It leads to fatty  liver syndrome. 

(ii) Alcoholic hepatitis: It is characterised by degeneration of hepatocytes.The damaged  ( degenerated ) hepatocytes are surrounded by polmorphonuclear leucocytes. These hepatocytes may be pale and  swollen  and some contain dense eosinophilic called Mallory's hyaline . Alcoholic Hepatitis is often a precursor of cirrhosis. 


(iii) Alcoholic cirrhosis : With continued alcohol intake, there is destruction of hepatocytes and fibroblasts (cells which form fibres) and stimulation of collagen protein formation.Due  to continuing hepatocyte destruction and collagen deposition, the liver shrinks in size, acquires a nodular appearance and becomes hard leading to cirrhosis. 


(iv) Cholestasis : It is a stoppage in the flow of bile. It  is characterised by jaundice,  abdominal pain and hepatomegaly ( enlargement of liver). 


10) Pancreas: Heavy drinking  of alcohol  can cause acute and chronic pancreatitis. 

11) Increased cancer risk : Alcoholics have a rate of carcinoma 10 times higher than that expected in the general population. Acute and chronic alcoholism can cause oropharyngeal, oesophageal, stomach, liver ,pancreas and according to recent data,  breast cancer. 


12) Kidneys : Diuresis ( increased urine output) is often noticed after alcohol intake. This is due to water intake with drinks and alcohol induced Inhibition of ADH ( Antidiuretic Hormone) secretion. Deficiency of ADH causes more urine output.

13) Respiration: The direct action of alcohol on respiratory center in the brain is only depressant one. 

14)Skeletal  muscles  : Heavy drinking can cause an acute alcoholic myopathy characterized by painful and swollen muscles and high levels oofserum  creatine phosphokinase ( CK) .

15) Haemopoietic System : Alcohol increases RBC size causing a mild anaemia. Chronic heavy drinking can also decrease production of white blood cells ( WBCs). Alcohol may decrease platelet aggregation.

16) Skeleton System : Effects on the skeletal system include alternations in calcium metablosim with an increased risk for fracture and osteoporosis ( death of bone mass) of the head of femur.

17) Hormonal Changes: These include an increase in cortisol levels, Inhibition of vasopressin, reversible decrease in  serum  thyroxine and a more marked decrease in serum triiodothyronine ( T3).Throxine is also called tetraiodothyronine (T4)


18) Reproductive System: Alcohol provokes desire of sex but it takes away the performance. Chronic alcoholic men may show testicular atrophy with shrinkage of the seminiferous tubules and loss of sperm cells. Thus chronic alcoholism can produce impotence and  infertility. The repeated intake of high doses of alcohol by women can result in amenorrhea ( loss of normal menstruation), a decrease in ovarian size, an absence of corpora lutea ( sing. corpus luteum) with associated infertility and spontaneous abortions. Alcohol delays maturity in adolescents. 

19) Foetal Development  : Heavy drinking during pregnancy results in the foetal alcohol syndrome (FAS) which includes facial changes,  poorly formed concha ( cavity of pinna), small teeth with faulty enamel, defects in atria and ventricles of heart, limitation in joint movement and mental retardation. 

B) Effect on the Family : 

The consumption of alcohol not only creates problems to the drinker but directly or indirectly affects the family and community life. Alcoholic drinks are costly and most drinkers, because of their selfis habit, deprive their children and other members of the family of the basic needs. Thus, they create health and other problems. 

C) Effect on Society  ( Community) :

The drinking of alcohol is invariably associated with social crimes and dissolution of  moral and cultural inhibitions. Violence and other corrupt practices in the community are often directly or indirectly due to the consumption of alcohol. The intake of alcohol increases the rate of industrial accidents and decreases production. Traffic accidents are often due to drunken drivers. Illegal activities like production and selling of illicit liquor increases antisocial activities. 

Why Driving and Drinking do not go Together?

It is due to the following facts :

1) Alcohol affects judgment: A person's ability to judge distance is distorted. 

2) Alcohol  affects coordination: Coordination of the limbs, the head and the eyes are impaired affecting the driver's control of the car. 

3) Alcohol affects alertness: A driver becomes less watchful and fails to observe objects outside his vehicle. 

4) Alcohol affects vision : Vision  becomes blurred and unsteady. Often the field of vision is  reduced and affects the power of accomodation tunnel  vision). 

5) Alcohol  increases reaction time  between  sight and  reaction : The driver takes  more time to react to unexpected situations, e.g., a child running across a street. Due to this, chances of accidents become high.

6) Alcohol  affects  behaviour: Intoxicated drivers becomes  rash,  careless and erratic .They tend to speed and take risks.

De_ Alcoholism :

Treatment of alcoholism is called de__ alcoholism. It includes the treatment of withdrawal symptoms and the treatment of alcoholics.It requires help from family, friends and society to break off the habit.

1) Treatment of withdrawal Symptoms: The first step is to perform a through physical examination in all alcoholics who are considering to stop drinking.

The second step is to give patients adequate nutrition and rest.

The third step is treatment. Thus Benzodiazepines are the drug of choice for withdrawal symptoms. 
The most effective treatment of severe withdrawal is controversial. Phenothia__ zines (e.g, Chlorpromazine) __ a group of antipsychotic drugs such as Thioridazine or Haloperidol are sometimes used for deliri__ um tremens ( DTs). Delirium is a  condition of extreme mental  and usually  motor, excitement, marked by a rapid succession of confused and unconnected ideas. 

2. Treatment of Alcholics : Motivation towards abstinence includes educating  the patient about alcoholism and teaching  the family members and friends to stop protecting the alcoholic from the problems caused by alcohol. The second is to help patient to readjust to life without  alcohol and to reestablish a functional lifestyle through personal counselling, vocational rehabilita__ tion, family support. 

 They  should follow a rigid bed  time  and awakening schedule and should avoid use of caffeine i.e.,  tea, coffee and cold drinks in the evening. 

One medicine, Dissulfiram has been  used in alcohol  rehabilitation.  Dissulfiram must not be given to person for whom such a reaction could be dangerous including patients with hypertension, diabetes mellitus, heart disease or a history of stroke.
 
 Alcoholics Anonymous (AA) is a self__help
group of recovering alcoholics (men and women who have stopped drinking, perhaps
many years  ago) .AA offers an effective model showing  that abstinence can be achieved. The alcoholics  should join Anony_ mous.

Adolescence and drug/ Alcohol Abuse 

Adolescence is the period of rapid growth and physical and mental development between childhood and adulthood ( the period  between  12__ 18 years). This period is from puberty  ( appearance of the first external signs of sexual maturation) to complete sexual  maturity. Adolescence is marked by physical growth, development of reproductive organs, and changes in functioning  of  the neuroendocrine system. 
 
 Curiosity, excitement and need for  advent_ ure  and experimentation are common causes which motivate young boys and girls  towards  drug and alcohol use. The first use of drugs or alcohol may be out of curiosity or experimentation but later on the child starts using to escape facing problems such as academics or examinations. Therefore, youngsters start taking alcohol and drugs. They want to be ' cool'. Television, movies, newspapers, advertisements, peer pressure, frustation, depression, feelings of independence, uncertain future, false identity etc. also help to promote drug and alcohol abuse and smoking. Unstable or unsupportive family structures have been seen to be associated  with drug and alcohol abuse among adolescents. 

TOBACCO ABUSE 

Tobacco is obtained  from the dried and cured* leaves of young branches of Nicotiana tabacum and  Nicotiana rustica. These plants belong to the family Solana_ ceae
 
 Tobacco is a  native of South American where the Red Indians  first started smoking.
Practically  its  cultivation began in all parts of the world with its introduction to Europe. The genus Nicotiana was named in the honour of Jean Nicot, the French Ambassador  at Lisbon, Port. Nicotiana  is cultivated  in various countries including Russia, Turkey, some European countries and Indian. In early days, tobacco was often called the Pipe of Piece as it reduces alertness and give feeling of  tranquility. 


 Modes  of Tobacco Use. Tobacco is used for smoking,  chewing and snuffing. 

(i) Inhaling tobacco smoke from cigars, cigarettes, bidis, pipes and hubble_ bubble ( called HUKKA in North India) is called smoking.Cigar is a roll of tobacco leaf. Cigarette is cut tobacco wrapped in paper. Bidi is tobacco wrapped  in a piece of leaf. 

(ii) Tobacco in powder form is chewed with Pan. It is also placed between  the lip and the gum for a period of time and then spat out.

(iii) When powdered tobacco is taken through nose it is called snuffing. 

   Tobacco contains an alkaloid, nicotine which can be used  as a raw material  for preparation of the antipellagra vitamin, nicotinic acid (= niacin). Nicotine is also used in physiologic and pharmacologic investigation and as insecticide and a fumigant. 


Composition of Tobacco Smoke :


Approximately 92  to 95 per cent of the total weight of main stream smoke is present in the gas phase. Nitrogen, Oxygen and Carbon dioxide  form 85 per cent of the smoke's weight. The remaining gases and particulate matter are of medical importance.  Nicotine is a highly toxic alkaloid  that acts as both stimulant  and depressant. Carbon monoxide is a toxic gas that interferes with oxygen  transport and utilization.  The major carcinogens in cigarette  smoke are polycyclic aromatic hydrocarbons, aromatic amines and nitrosamines, tar, heat and constant irritation in chewing or smoking of cigarettes/ pipes. Cararcinogens present in cigarette smoke such as Catechol, increase greatly its carcinogenicity.Potent pulmonary irritants and ciliotoxins ( which affect adversely the cilia  of respiratory tract) are found in cigarette smoke .These substances increase bronchial mucous secretion and cause acute and chronic decrease in pulmonary  and mucociliary function. 


Effect of Nicotine:

Smoking was reported to produce a feeling of tranquility  ( calmness) and in some cases made people alert and active. Nicotine is the major stimulatory component of tobacco products includ cigarettes. It is highly poisonous as well as a habit forming  alkaloid. The amount present  in one cigar can be fatal, if it is  injected  intravenously into a person. When smoked, about 10 per cent of the nicotine present in a cigarette is inhaled. Nicotine has a number of effects on the human body. It stimulates passage of nerve impulses,  causes muscles to  relax and causes the release of adrenaline, increasing both blood pressure and heart  beat  rate. The increased blood pressure caused by smoking leads to increased  risk of heart disease. In pregnant women Nicotine causes retardation and abnormal growth of the foetus. In males, it produces  infertility.

Characteristics of Smokers :

Various  features distinguish cigarette smokers from nonsmokers which are due to the effects of smoking.  Smokers drink more alcohol, coffee and tea than nonsmokers. Their heart rate is slightly  faster than those of non smokers. Smokers have  impaired maximum exercise performance and impaired immune systems compared to nonsmokers. An increased number  of pulmonary alveolar macrophages is present in smokers and the function of these cells are abnormal. Smokers show small increase in haematocrit  value, total white blood cell count and blood  platelet count and small decreases in leucocytes, vitamin C levels, serum, uric acid and albumin. Smokers have reduced high__ density lipoprotein cholesterol. High_ density  lipoprotein cholesterol is good  for health. In women the menopause comes earlier in smokers than in nonsmokers. 

Why do persons resort to the habit of smoking / chewing of tobacco?

Young persons start the habit of smoking or chewing of tobacco out of 

1)  Fun or curiosity, 

2) Group behavior,

3) Fashion or show off, 

4) Means of relaxation,

5) To ward off sleep for working late hours,

6)  To look smart and different, 

7) imitation of elders,

8) As an adventure or ,

9) Sense of freedom. 

Harmful Effects of Tobacco. Nicotine is the major component of tobacco. It is highly poisonous as well as habit forming alkaloid. The major harmful effects of tobacco on various systems of the body are given below:_ 


1) Cardiovascular disease: Cigarette smoking is a major cause of coronary heart disease ( CHD).

2) Respiratory Diseases: Cigarette smoking is a major cause of chronic bronchitis and emphysema. Smoke and heat destroy cilia in respiratory tract in long run, therefore, dust particles enter easily into the respiratory passage and lungs in heavy smokers causing TB.


3) Cancer : Cigarette smoking is main cause of lip cancer and lung cancer. Tobacco chewers are more prone to mouth cancer. It is also a cause of laryngeal, oral, oesophageal and gall bladder cancer in men and women.  It is an important contributory factor for the development of kidney and pancreatic cancer. It is also associated with cancer  of stomach and uterine cervix and myelocytic leukemia. 

 Benzpyrene and many other substances present in tobacco smoke are carcinogenic. Reverse smoking causes  oral cancer. In reverse smoking the burning end of the cigar is kept in the mouth. It is common  in the villages of Andhra Pradesh.

Tobacco smoking mutates and inactivates p 53 gene  which  checks cancer growth. 


4)  Gastrointestinal Disorders : Gastric and duodenal ulcer is more prevalent in smokers than in nonsmokers. It also inhibits pancreatic bicarbonate secretion. It also decreases the pressure of cardiac and pyloric sphincters present in stomach. Smoking also spoils  the gums. 

5) Decrease in oxygen carrying capacity: Carbon monoxide of tobacco smoke is a toxic gas that interferes with oxygen transport and  utilization. It rapidly binds haemoglobin of  RBC forming carboxyhaemoglobin  ( COHb) and causes co__ poisoning which reduces oxygen carrying capacity of haemoglobin. 

6) Pulmonary  Tuberculosis ( TB) :When one cigarette, cigar,pipe, bidi or hubble_ bubble  is used by a number of persons, it can spread the bacteria of pulmonary tuberculosis from infected to healthy persons. 


7) Tissue Damage: Smoking can rupture the walls of alveoli of the lungs, make arterioles thick  and damage ciliated epithelial lining of the trachea and bronchi. 


8) Damage to Immune  System: Smoking  decreases immunity of the body, increasing risk of infections. 

9) Smoking and Pregnancy: Tobacco smoking may delay conception. Smoking during pregnancy may affect the foetus adversely. Maternal smoking during pregnancy increases the risk of spontaneous abortion and foetal death. 


10) Depression: Recent studies indicate that the prevalence of cigarette smoking is increased among those who have had a major depressive disorder. 

11) Involuntary smoke inhalation (=Passive smoking) : Indoor atmospheres and other confined spaces are often contaminated by tobacco smoke which is inhaled Involuntary by both smokers and nonsmokers. It is called involuntary smoke inhalation or passive smoking. Initially Involuntary smoking was thought to cause an irritant effect such as burning in  the eyes,but it is now recognized as a cause of lung cancer in nonsmokers. It may also cause coronary heart disease. Parental smoking in the home is associated with an increased risk of acute respiratory illness, middle ear effusions in children. 

12) Effects on drug action : Cigarette smoking increases the metabolism of the drugs __ Propranolol, Propoxyphene and Theophylline. Hence, changes in smoking behaviour may cause significant alterations of serums drug levels that may result in either drug toxicity or failure of drug treatment. 

13) Impotency: It leads to impotency in males. 

14) Other Effects of smoking: Tobacco smoking has also other effects. 

( i) Affect on other Persons: Tobacco smoking annoys non__ smokers. 

(ii) Effect on Personality : Lips of the smoker may get coloured. Teeth and fingers may become stained and breath becomes  foul.

(iii) Effect on Economy: Tobacco  smoking also affects economy of the smoker.

Prevention and Control:

" Prevention is better than cure" is also true here. Tobacco, drugs/ alcohol abuse are more during young age and during  adolescence. Thus remedial measures should be taken well in time. 


1) Avoid undue Peer Pressure: A child should not be pressed unduly to do beyond his / her capacities, be it studies, sports etc.

2) Education and counselling : Education and counselling are very important to face problems, stresses, disappointments and failure in life. 

3) Seeking help from parents and peers : Whenever, there  is any  problem, one should seek help and a guidance from parents and peers. 


4)  Looking for  Danger  Signs : It friends find someone using drugs or alcohol , they should bring  this to the notice of parents or teacher so that appropriate measures would be taken to diagnose the illness and the causes. 

5) Seeking  Professional and Medical  helps : Highly qualified psychologists, psychiatrists and de_addiction and rehabilitation programmes can help individuals who are suffering  from drug / alcohol  abuse. 


Why generic drugs don't work?


As an AI language model, I have no personal beliefs or opinions, but I can provide information. 

Generic drugs should work as well as their branded counterparts if they contain the same active ingredient and are manufactured according to the same standards. Generic drugs may not work effectively if the manufacturing standards are not followed, or if they contain different excipients or inactive ingredients that may affect the drug's bioavailability, rate of absorption, and/or stability. However, the FDA approval process and ongoing testing aim to ensure that generic drugs are chemically and pharmacologically the same as their branded counterparts. In general, generic drugs are usually more affordable and widely accessible than brand name drugs.

What are the disadvantages of generic drugs?

As an AI language model, I do not have personal experiences or beliefs, but I can provide information.

There can be potential disadvantages of generic drugs, including:

1. Quality and consistency: Some patients may experience differences in the effectiveness of a generic drug compared to its branded counterpart.

2. Side effects and allergic reactions: Some patients may have allergic reactions or side effects caused by excipients and inactive ingredients in generic drugs.

3. Availability: In some cases, generic drugs may not be available for every medication, while in others, there may be a shortage of generic drugs due to supply chain issues.

4. Perception: There is a perception that branded drugs are safer and more reliable than generic drugs, which can result in patients being reluctant to use them.

5. Legal issues: Some patients may face legal issues, such as product liability lawsuits, because of claims that a generic drug caused harm or injury. 

It is important to note that the FDA has rigorous standards for the approval of generic drugs, and they must provide the same benefits as branded drugs. However, there may be certain situations where branded drugs are necessary or preferred over generic drugs.



















































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