PH3.9 | PH3.9 | Dependence-Producing Drugs and De-Addiction Management — SDL Guide — Summary & Reflection

KEY TAKEAWAYS

Dependence-producing drugs converge on the mesolimbic dopamine reward circuit (VTA → nucleus accumbens). Stimulants: cocaine (DAT/NET/SERT reuptake blocker), amphetamines (catecholamine releasers), caffeine (adenosine antagonist), MDMA (5HT/DA releaser). Depressants: cannabis (CB1 agonist), alcohol/opioids/BZDs (covered in PH3.8/3.4/3.2). Psychedelics: LSD (5HT₂A partial agonist — no physical dependence, rapid tolerance). DFSA drugs: GHB (GABA-B agonist — amnesia, 4-8h urine window — collect specimens immediately), flunitrazepam, ketamine. De-addiction pharmacotherapy: OUD — buprenorphine/naloxone (maintenance, outpatient), methadone (supervised), naltrexone (post-detox relapse prevention — must not give before full detoxification); tobacco — NRT, varenicline (partial α₄β₂ nAChR agonist — most effective), bupropion; alcohol — disulfiram/naltrexone/acamprosate (PH3.8 cross-ref).

REFLECT

A 22-year-old woman is brought to your emergency department at 3 AM by her friend who says she was at a party and 'was fine one minute, then completely incapacitated — she couldn't walk and seemed confused and then very drowsy' after accepting a drink from a stranger. Drug-facilitated sexual assault is suspected. What are the three immediate clinical priorities (medical + forensic + psychosocial), and which specific pharmacological agents would you be concerned about? For each suspected agent (GHB, flunitrazepam, ketamine), what is the mechanism of the amnestic effect and what is the critical forensic sampling consideration?