Controlled Drugs and Drug abuse

Question 1

What is a controlled drug?

Answer 1

The Misuse of Drugs Act 1971 defines Controlled Drugs (CDs) as drugs which are ‘dangerous or otherwise harmful’ and have the potential for abuse or misuse

Question 2

What is addiction?

Answer 2

Addiction is defined as not having control over doing, taking or using something to the point where it could be harmful to you.

Question 3

Is it acceptable to give morphine/control drug for a wrist fracture?

Answer 3

(1. ) Morphine is a potent analgesic which is very useful for patients in severe pain.
(2. ) Maisie was given this as she had severe pain, in the short term there will be no issues with addiction.

Question 4

Give some examples of when controlled drugs are used in General Practice

Answer 4

Oramorph, oxycodone, codeine, tramadol, fentanyl, methadone, and diazepam are examples of controlled drugs used in general practice.

Examples of when they are used include acute and chronic pain, addiction, severe back pain and muscle spasm

Question 5

Name two common prescription drugs of abuse?

Answer 5

(1. ) Benzodiazepines (diazepam most common)

(2. ) Opioids (codeine and tramadol) are the commonest prescription drug of abuse.

Question 6

What are common presentations of drug seeking behaviour

Answer 6

(1. ) Patients will often present requesting prescriptions early.
(a. ) This can either be due to an excuse (I lost some, some were not in the packet from the pharmacy etc)
(b. ) or simply suggesting that you must be wrong when suggesting that they should have run out by now.

(2. ) It is also not uncommon for these patients to complain of pain that is not being managed with continually escalating need for analgesia and often they can end up on high doses of analgesia very quickly.
(3. ) Benzodiazepine addicts tend to present the same but insomnia may be cited as the main cause with higher doses needed to manage

Question 7

Give an example of two weak opiates and 3 strong opiates commonly prescribed to patients

Answer 7

(1. ) Weak opiates = codeine, dihydrocodeine.
(2. ) Tramadol sits somewhere in the middle.
(3. ) Strong opiates = morphine, diamorphine, fentanyl and buprenorphine

Question 8

How do opioid analgesics work?

Answer 8

(1. ) Opioid analgesics work by mimicking endogenous opioid peptides (released from the dorsal horn relay neurones)
(2. ) Giving a prolonged agonist effect on opioid U receptors in CNS, which reduces neuronal excitability and pain transmission.
(3. ) This causes analgesia, respiratory depression, euphoria and sedation.

Question 9

What are the common side effects of opioid analgesics?

Answer 9

(1. ) N + V
(2. ) constipation
(3. ) Respiratory depression (for strong opiates)
(4. ) Ongoing treatment with opiates also leads to tolerance and dependence

Question 10

Life-threatening opiate overdose is a common presentation in those abusing these medications or taking illegal alternatives. How is this managed? Does it have any risks?

Answer 10

(1. ) Naloxone = competitive antagonist at opiate receptors
(2. ) Leads to very rapid reversal which can cause withdrawl symptoms
(3. ) Naloxone has a shorter action than opiates and therefore the side effects can return if the patient is not monitored and further doses given as needed