Drug misuse Flashcards
What is in the ICD-10 addiction definition?
Craving
Tolerance
Compulsive seeking behaviour - differentiate from dependance
Physical effects of drug use (acute and chronic)
Acute - Injecting - DVT, abscess - OD and resp depression - Poor pregnancy outcomes - Opiate SE - constipation, etc. Chronic - Blood-borne viruses (Hep C 50% in IVDU)
Social effects of drug use
Family break down
Crime
Poverty and homelessness
Psychological effects of drug use
Fear of withdrawal
Craving
Guilt
Heroin - route
Any
Heroin - lasts
6-8 hours
Heroin - effects
Escape from real world
Heroin - adverse effects
Dependance
Physical - nausea, itching, sweating, constipation
OD
Cocaine - route
oral
snorting
smoking
IV
Cocaine - MOA
Blocks re-uptake of serotonin and dopamine neurotransmitters (more of it floating about)
Cocaine - acute effects
Intense pleasure
Anxiety, panic
Adrenaline secretion - confidence, euphoria, energy, alertness, impaired judgement
Cocaine - chronic effects
Paranoia, psychosis, damaged nasal septum, respiratory (crack lung)
Aims of drug tx
Reduce harm to - user, family and society
Improve health
Stabilise lifestyle - reduce amount of drug use
Reduce crime - benefits for wider society
What help can be offered
Health check
Screening for blood borne viruses
Contraception
Smear
Sexual health
Immunisations, especially Hep C
Signpost - benefits, counselling, housing, local drug programmes (e.g. needle exchange)
Main principle of tx
Harm reduction (px of death and blood borne disease)
Drugs used for detoxification
Lofexidine
Buprenorphine
How does Lofexidine work?
Reduces withdrawal symptoms (not an opioid)
How does buprenorphine work?
Reduces withdrawal symptoms (weak opioid), used for first two days
What drug is used for maintenance tx?
Methadone
How does methadone work?
Weak opioid
Do NOT prescribe to those that take lots of heroin
Relapse prevention medication
Naltrexone
Naloxone
How does naltrexone work?
Feel unwell if take heroin as well
- Regular urinalysis to ensure taking the drug
How does naloxone work?
Opioid receptor antagonist medication that can eliminate all signs of opioid intoxication to reverse an opioid overdose. It works by rapidly binding to opioid receptors, preventing heroin from activating them.
Psychological interventions
AA
Motivational enhancement therapy
’12 Step Programmes’
Family therapy
Who else is involved in a drug users care?
Referral for allied problems
- Hep C
- STDs
- etc.
What is involved in a rapid assessment of a drug user?
What drug?
Route?
How long addicted?
Patient’s goals?
Referrals needed?
Any other medical problems/ complications
- Interagency involvement?
Use of methadone for inpatients
Confirm dose on admission
Do not give with benzodiazepines
Be careful with methadone and analgesia (continue with normal pain ladder)
Pain needs treating, as with anyone else
Must have a prescription when discharged (akin to discharging a diabetic without their insulin)
What is spice?
Legal high - but now illegal
Potent cannabinoid - high concentration of THC (made, not grown)
‘Zombie state’ - no control over potency so dosing varies massively between doses
Many accidental ODs
Smoked in a spliff
What national guidelines are there for treating drug users?
Drug Misuse and Dependance: Guideline on Clinical Management, 2007
What does the GMC say about drug users?
Drug users have the same right to the NHS as all other patients
All patients have a right “to high quality care, irrespective of their medical condition”
