Drug Misuse and Addiction

Question 1

Which groups of people are at higher risk of drug misuse?

Answer 1

Mental health issues
Sexual exploitation or assault
Commercial sex work
LGBTQ
Unemployed
In care
Family/carer drug use
Homelessness
Clubbing or festivals
Uses drugs occasionally/recreationally

Question 2

What are some signs of drug abuse?

Answer 2

Lack of energy
Weight loss/gain
Red eyes
Neglected appearance
Withdrawn and unsociable

Question 3

What are some commonly abused drugs?(7)

Answer 3

Phenobarbital - euphoria, excitement.
Benzodiazepines - sedation, reduced anxiety, lowered inhibition, feeling of wellbeing.
Opioids - pain relief, euphoria, sedation.
Amphetamines (Adderall) - increased energy and alertness, exhiliration, weight loss
Cyclizine - euphoria, hallucinations, anti-emetic effect allows higher intake of other drugs and alcohol without vomiting.
Pregabalin/Lyrica - euphoria, calmness, enhances effect of other drugs.
Sudafed/pseudoephedrine - used to make crystal meth.

Question 4

How do opioids cause addiction?

Answer 4

Activate mu opioid receptors in the central and peripheral nervous system which results in pain relief, as well as euphoria and sedation. Patients build tolerance to them and can experience unpleasant withdrawal symptoms if stopped abruptly, making taking them even more attractive.

Question 5

What are some early symptoms of opioid withdrawal?

Answer 5

First 24 hours: MS RAIN
Muscle aches
Sweating
Restlessness
Anxiety
Insomnia
Nose - runny nose

Question 6

What are some later symptoms of opioid withdrawal?

Answer 6

DANG
Dilated pupils and blurry vision
Abdominal cramping
Nausea and vomiting
Goosebumps

Rapid heart rate
High blood pressure

Question 7

How long do opioid withdrawal effects last?

Answer 7

Symptoms improve within 72 hours, and usually resolve within a week.

Question 8

How can opioid withdrawal symptoms be prevented?

Answer 8

Opioid substitution therapy:
Methadone
Buprenorphine

Question 9

Why is methadone preferred over buprenorphine for opioid substitution therapy?

Answer 9

Methadone - better at keeping people in treatment.
Buprenorphine - higher risk of fatal overdose in first week.

Question 10

How long is methadone usually supervised for?

Answer 10

3 months

Question 11

Other than initiation, when else would methadone administration need to be supervised?

Answer 11

If they have taken a break
If their dose has increased
If they have used other opioids

Question 12

What should be considered before changing a methadone patient from supervised to unsupervised administration?

Answer 12

Reasons for reducing supervision.
Ongoing drug or alcohol use.
Their characteristics, such as mental health, impulsivity, and history of overdoses.
Their home environment and presence of other vulnerable people.
Safe storage facilities at home.

Question 13

What is the minimum amount of supervision permitted for a methadone patient?

Answer 13

One collection and supervised consumption every 7 days.

Question 14

During methadone-assisted opioid withdrawal, what should be monitored?

Answer 14

Other drug use - may require dose adjustment, alteration to dispensing regimen, renegotiation of goals, or referral to psychological interventions.

Signs of withdrawal/insufficient dose

LFTs - baseline and every 6-9 months to monitor for signs of cirrhosis

ECG (if risk factors) - for QT interval prolongation.

Respiratory depression - on treatment initiation.

Question 15

What kind of prescription is methadone prescribed on?

Answer 15

Instalment prescription

Question 16

What are the signs of cirrhosis on LFT?

Answer 16

Low total protein, albumin, or platelet count.

Question 17

What must apply for an instalment prescription to be legally valid?

Answer 17

State the amount of medicine to be supplied per instalment, in addition to the dose.

State the interval between each time the medicine can be supplied.

State the date of each supply.

Be dispensed no later than 28 days after the appropriate date (either date of signature or start date, whichever is later).

Question 18

What should be done if a methadone patient misses a dose?

Answer 18

Assess the reason for missed dose.

Assess for signs of withdrawal or substance use.

Do not double dose.
If 1 or 2 days is missed, give the usual dose.
If 3 days is missed, contact prescriber as they may have reduced tolerance.

Question 19

What should be done if a misuser cannot pick up their instalment?

Answer 19

They can send a representative to collect it on their behalf, but they must first provide a letter authorising the representative by name each time. The representative should bring ID to support this.

Question 20

If a methadone prescription states that the dose has to be supervised but a representative has come to collect the prescription, what should be done? What is the exception to this?

Answer 20

Contact prescriber to obtain verbal consent to supply without supervision.

Exception: if the patient is in custody and the representative is a police custody officer/professional. Administration of a schedule 2 or 3 CD in custody will always be supervised by a HCP.

Question 21

Other then methadone and buprenorphine, what else can be prescribed for addiction?

Answer 21

Cocaine, diamoprhine (heroin), and dipipanone.

Question 22

Who can prescribe cocaine, diamoprhine (heroin), and dipipanone?

Answer 22

For disease and injury: medical, independent, and supplementary prescribers.

For addiction: only medical prescribers.

Question 23

How does methadone work for opioid dependence?

Answer 23

Methadone is a synthetic opioid agonist that eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids so, in an opioid-dependent person, treatment doses do not produce euphoria.

Question 24

How does lorazepam work?

Answer 24

It binds to benzodiazepine receptors on the postsynaptic GABA-A ligand-gated chloride channel neuron at several sites within the central nervous system (CNS) and enhances the inhibitory effects of GABA, which produces a calming and sedating effect.