Addiction

Question 1

How do you calculate units?

Answer 1

Unit equation: % strength x ml /1000 = units

Question 2

What are the major causes of morbidity and mortality associated with substance abuse?

Answer 2

Trauma (e.g. fractures)
Road Traffic Accidents
Homicide
Suicide
Overdose (deliberate, and frequently accidental)

Cirrhosis (Alcohol)
Endocarditis (IV)
Abscesses (IV)
BBV: Hepatitis B/C & HIV (IV)
(ask about vaccinations)

Question 3

What aspects of assessment are specific to alcohol?

Answer 3

Note any history of Alcohol related seizures, Delirium Tremens, Alcohol psychosis, haematemesis, melaena ?

Question 4

What are the specific examinations for alcohol?

Answer 4

Comment on the presence of jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT

Question 5

What are the specific investigations for alcohol?

Answer 5

Fibro scan / Ultrasound
Bloods (LFT, GGT, Lipids, U&E, amylase)
Breathalyser
Urine Drug Screen

Question 6

What examinations are specific to opioids?

Answer 6

Collapsed veins / track marks
Endocarditis 
Skin abscesses
Hepatitis / HIV
Pneumonia

Question 7

What are the specific investigations for opioids?

Answer 7

Bloods (LFT, U&E, GGT, Glucose)
Breathalyser
Urine Drug Screen
Sexual health screening/BBV

Question 8

What is the screening tool for alcohol?

Answer 8

Cut down
Annoyed
Guilty
Eye-opener
CAGE or AUDIT Test

Question 9

What do opioids do?

Answer 9

Relieve pain – ANALGESIC effect

Create a sense of EUPHORIA

Question 10

How do opioids effect you?

Answer 10

Don’t forget Endogenous ENDORPHINS also regulate pain & mood, vs Exogenous DRUGS

Opioid receptors mu, delta, kappa effected by opioid agonists (heroin, methadone, fentanyl, codeine), 
	partial agonists (Buprenorphine), antagonists (Naltrexone)

Question 11

What is the difference between opioids and opiates?

Answer 11

Opiatesrefer to naturalopioidssuch as morphineandcodeine, and heroin to some extent.
Opioidsrefer to all natural, semisynthetic,andsyntheticopioids.

Question 12

What are the signs of opiate overdose?

Answer 12

Not moving/Can't be woken
Slow or no breathing
Choking/gurgling sounds/snoring
Tiny pupils
Clammy/Cold skin
Blue lips & nails

Question 13

When were the opioid epidemics in the US?

Answer 13

the first beginning in the 1990s, from prescription opioids
the second beginning in 2010, involving heroin
the third beginning in 2013 and involving synthetic opioids, especially fentanyl

Question 14

How many people die of opioid use in the UK?

Answer 14

There were 4,359 deaths from drug poisoning in 2018

This is up 16% from the previous year and is the highest annual increase since records began in 1993

Deaths amongst men increased from 89.6 per million in 2017 to 105.4 per million in 2018 - two thirds of these were linked to the misuse of drugs

Opioids, such as heroin and morphine, continue to be the most frequently mentioned substances on death certificates