Medico Legal Importance of Drug Abuse Detection Before Emergency Operation

Drug addiction has become a more common problem worldwide. In many countries drug abuse is rapidly increasing among young generations .By taking routine preoperative history, it has been noticed that there is a high percentage of patients who were addicted to different types of drugs. Drug addiction remarkably increases morbidity and mortality among patients. Addiction could be defined as a chronic disorder characterized by the compulsive use of a substance, resulting in physical, psychological or social harm to the user and continued use despite that harm .

Substances that could be abused are so many: alcohol, sedative and hypnotics, opioids, cocaine and amphetamines, cannabis, hallucinogens and nicotine. They can be classified as socially acceptable drug (e.g., alcohol, tobacco), a medically prescribed drug (e.g., diazepam), and illegal substance (e.g., cocaine) .

Both acute intoxication and chronic abuse of these substances present challenges for anesthetic management during and after an operation .Whereas some procedures may be delayed while the issue is addressed, others are urgent or emergent and the surgeon and anesthesiologist must be able to deal with the physiologic changes that may occur in these patients.

So, it is important to understand the situations of drug users, such as the category of drugs used, the dosage, the duration of drug use, their history of detoxification or abstention, and especially their current abuse of drugs. Pain threshold in addicts is lower than ordinary people who are not addict to opium due to several reasons including change in function, sensitivity reduction, or decrease in opioid's receptors.

Nevertheless, they are more resistant against narcotics and analgesic drugs. With little information about the history of drug abuse, a quick screening for recent use of drugs is important for both medical staff and patients. The immune colloidal gold (ICG) technique is a well-established technique and is commonly used for screening for drug abuse .