Drug misuse 3 (treatment) Flashcards
Describe the cycle of the change model as applied to drug misuse
Pre contemplating Contemplating Determination to stop Action Maintenance Relapse
Discuss the contribution that pharmacist can make at different stages of the change model
A
Describe the short and long term withdrawal effects associated with opiate withdrawal
Short term
- Timing : start after 4-6 hours (peak arounnd 72hrs)
- symptoms : “flu like” - profuse sweating, chills, piloerection, muscle twitching, diarrhoea, agitation, insomnia
Long term
- timing : last several months
- symptoms: anorexia, insomnia, lethargy, craving
Describe the arguments for and against prescribing drugs at NHS expense to drug misusers
A
Describe the aims of the substitute prescribing and detoxification prescribing
And explain why dosages are adjusted up and down
Opioid substitution therapy:
- Replace the illicit drug (heroin) with a free legal drug taken orally
- options include oral methadone and buprenorphine
- see bnf, chapter 4 - cns , 8 - substance dependence»_space; 8.3 - opioid dependence
Describe the advantages and disadvantages of the different preparations (methadone and buprenorphine) used in treatment drug misusers
A
Benefits of oral treatment
Patient
•stabilise chaotic lifestyle
•reduced:
-Damage to veins from injecting
-Need to resort to crime
-Need for sharing syringes etc
Society • reduced spread of blood borne infections •reduced criminal activity -personal loss through theft - police time saved • fewer discarded used syringes •cuts homelessness figures • less dependence on welfare payments
Methadone treatment
•compared to heroin
•effects
-less intense (“high”)
-longer half life (24-36 hours)
>> suitable for daily dispensing
•formulations
- oral mixture 1mg/ml (DTF)
- tablets 5mg (not suitable for drug misusers)
Dosage - 1st stage (substitute prescribing) •start low •gradually increase dose •stabilise on maintenance dose - 2nd stage (detoxification) •reducing dose
Supervised methadone treatment
•SAM
- supervised self administration of methadone (SSMA)
This is basically when a patient takes the methadone under supervision so it is definitely taken
- prevents leakage onto black market
- minimises harm
- allows treatment to monitored
Buprenorphine treatment
•Buprenorphine
- used sublingually
- available in 2mg and 8mg
- duration or action 48-72hours
•compared to methadone
- less sedating
- safer in overdose
(Difference between the two)
- is classed as partial antagonist and agonist as it stimulates the receptors so you get the good feeling of taking the opioid and it also blocks the receptors therefore safer in overdose
Buprenorphine - key aspects for pharmacist
- withdrawal effects often seen during the 1st two days
- start at 4mg per day and increase by 4mg a day
- missed doses (are a concern)
- crushed tablets
Detoxification
•enforced withdrawal is ineffective
The patient must be ready
•gradually reduce dose
- usually takes:
• up to 4wks for inpatients (those in hospitals)
• up to 12 weeks in the community
- after abstinence:
•futher support should be provided for 6 months
•manage withdrawal symptoms OTC medicines to help deal with symptoms: - loperamide - mebeverine - NSAIDs - Rubefacients POM - lofexidine (Britlofex)
Preventing relapse
Neltrexone
- opioid antagonist
- start 7-10 after last opioid taken
Blocks receptors (so instant withdrawal effect) so can be taken if relapse
Drug misuse costs
Annual drug misuse NHS cost
£488million
Cost of deaths due to drug misuse
£2.4 billion
Annual cost of drug related crime
£13.9billion
Every year drug misuse costs society £15.4 billion
- treatment is coat effective
- every £1 spent on drug treatment saves £2.50 in costs to society
- Cannabis: most commonly misused illegal drug
- heroin: illegal drug most often requires treatment
- harm reduction: accepting there will always be some people who will misuse drug and helping them to do so safely as possible
- cost effective: the treatment of drug misusers is
