Illicit substance misuse Flashcards
Classification of drug use
- Hazardous use
- Harmful use
- Dependence
Definition of hazardous use of drugs
- Drug use that is likely to lead to harm
Definition of harmful use of drugs
- Drug use which causes damage to health(physical or mental)
Definition of drug dependence
- Pattern of ongoing use that is hard to stop
Signs of drug dependence
- Withdrawal
- Compulsion
- Salience
- Persistence despite evidence of harm
- Impaired control
- Tolerance
Give examples of behavioural, cognitive and physiological phenomena that develop after repeated substance use
- strong desire to take the drug
- difficulties controlling it’s use
- use despite harmful consequences,
- a higher priority given to drug use over other activities
- increased tolerance
- sometimes withdrawal”
What is the clinical presentation continuum
- Withdrawal(negative effects) - sober - intoxication(negative effects)
Physical complications of drug addiction
- Specific drug effects
- Contaminants
- Method of use
- Lifestyle
Mortality of drug addiction
- 1-2%/year
- 1500 deaths per year
Reasons for mortality from drug addiction
• Overdose • cellulitis • abscesses, thrombophlebitis • arterial occlusion • septicaemia • endocarditis • TB • respiratory infections • Hepatitis HIV
Psychiatric complications of drug addiction
- Drug misuse (intoxication / withdrawal) can mimic most psychiatric syndromes.
- Drug misusers increase rate psychiatric illness
- anxiety (28%)
- depression (26%)
- PD (18%)
- schizophrenia (7%)
- Suicide risk x 15
Cardiovascular complications of cocaine use
- BP increases
- MI
- Arrhythmias and sudden death
CNS complications of cocaine use
- CVA’s
- Seizures(lowers threshold)
Infective complications of cocaine use
- Abscesses
- Cellulitis
- Hepatitis
- SABE
- Septicaemia
- HIV
Respiratory complications of cocaine use
- Chest pain
- Dyspnoea
- Lung damage “crack lung”
- Respiratory failure
A general complication of cocaine use
- Weight loss
Obstetric complications of cocaine use
- Miscarriage
- Premature labour
Psychological complications of cocaine use
• Crash (Withdrawal) • Irritability, restlessness, fatigue, hypersomnia, hyperphagia • Anxiety especially panic • Depression / Mania • Anti-social behaviour • Paranoid Psychosis • Tactile / visual hallucinations. “Cocaine bug ” Repetitive behaviour
Signs of opiate intoxication
- Euphoria / relaxation
- Feeling of well being
- Constricted pupils
- Drowsiness
- Slurred speech
- Poor attention and concentration
Short-term effects of heroin
Central - euphoria, alternately alert and drowsy state
Mouth - Dryness
Skin - warm flushing
Respiratory - slowed breathing
Muscular - weakness
Opiate abstinence syndrome
- Drug Craving
- Anxiety
- Drug-seeking behaviour
- Yawning
- Sweating
- Running eyes and nose
- Restless sleep
- Dilated pupils
- Goose flesh (“cold turkey”)
- Hot and cold flushes:
- shivering
- Aching bones and muscles
- Loss of appetite
What are the majority of deaths from illicit opiate consumption due to
- Overdose
Why is an opiate overdose the most common reason for death
- Accidental
- Suicide attempt
- Latrogegenic
Triad of symptoms pointing to an opiate overdose
- Unconsciousness
- Respiratory depression
- Pin point pupils
Treatment for an opiate overdose
- Establish airway
- Ventilate(100% O2)
- Naloxone IV/IM
- Repeat 2-3mins
Signs and symptoms of an opiate overdose
- Decreased level of consciousness
- Cyanosis
- Skin cold and clammy
- Pupils pin point(later dilated)
- Muscles flaccid(can cause rhabdomyolysis)
- Respiratory arrest
- Cardiac arrest
When to refer to specialist services
- Unable to make changes following brief intervention & needing further help?
- Dependent – with a history of withdrawal?
- Showing a high level of alcohol / drug related harm?
- Previously known to treatment services?
- Pregnant / breast feeding?
- Experiencing mental health issues?
- Mixing drugs, prescribed or illegal or legal?
What is substance misuse
A person with a substance misuse problem is any person who experiences physical, psychological, social or legal problems as a consequence of their own repeated use of a substance, or the repeated use of a substance/s by other persons
What is harm reduction
A term that defines policies, programmes, services & actions that work to reduce the: Health, social and economic harms to: • individuals • communities • society that are associated with the use of drugs (Newcombe 1992)1. Harm reduction is: • Pragmatic • Prioritises goals • Has humanist values • Focuses on risks and harms • Does not focus on abstinence • Seeks to maximise the range of intervention options that are available
General harm reduction methods
- Advice around route of administration
- Test dosing and dosage information
- Advice on poly-drug use
- Research
- Consider ‘self’ and ‘setting’
- Have a ‘sitter’
- Thinking about safe sex
- Getting home safely
- Consider sleep and nutrition
Examples of depressants
- Alcohol
- Heroin
- Methadone
- Diazepam
- GHB/GBL
Examples of stimulants
- Caffeine
- Mephedrone
- Cocaine
- Ephedrine
- Amphetamine
Examples of hallucinogens
- Salvia
- LSD
- Ketamine
- Methoxetamine
- Mescaline
- Psilocybin mushrooms
What is heroin? (brown, gear, smack, H)
- Opiate; depressant derived from the opium poppy
What does heroin look like
- Brownish powder which comes in ‘baggies’. Class ‘A’
How is heroin used
- Smoked, usually on foil; ‘chasing the dragon’, or dissolved in water, mixed with an acid, heated & injected
Immediate effects of heroin
- intense sense of wellbeing, relaxed, drowsy and detached from emotional or physical pain. Slows the brain, heart rate and breathing. First time users may become sleepy, itchy and sick.
Risks and harms of heroin
- Can cause powerful physical & psychological dependency. Legal and social risks. Overdose risk, especially if mixed with alcohol or benzo’s; also after period of abstinence e.g. in prison, hospital or recovery
What is crack(white rocks, snow)?
- Smoke-able form of cocaine, water-insoluble cocaine base(or freebase)
What does crack look like
- Small ‘raisin-sized’ pieces, off- white, waxy. Class A
How is crack used
- Smoked, usually in a pipe, dissolved in water and injected
Immediate effects of crack
- Similar to cocaine but much more intense and short-acting
- Crack use is harder to control than cocaine as the high is so intense
Risks and harms of crack
- Breathing problems ‘crack lung, crack cough’
- If injected, it is really harmful to veins as it doesn’t dissolve easily
What is cannabis
- Naturally occurring, made from the cannabis plant. The main active chemical in it is tetrahydrocannabinol (THC for short).
What does cannabis look like(marijuana, mary jane, weed, grass)
- solid, dark lump (resin); or leaves, stalks & seeds (marijuana, grass).
Class ‘B’.
How is cannabis used
- rolled (usually with tobacco) in a joint / spliff; smoked in a pipe; eaten in food.
Immediate effects of cannabis
- Giggles, ‘munchies’, being talkative, more confident, or more anxious or paranoid. Tiredness and lack of energy, memory loss, breathing disorders and cancers (especially if used with tobacco).
Risks and harms of cannabis
- May trigger or exacerbate mental health problems
especially where there is a family history
What is spice
- Chemical mixture that is up to 100x more potent than THC
What does spice look like
- Raw form is crystalline white power
Effect of spice
- Cn cause strong hallucinogenic effects
Withdrawal symptoms of spice
- Physical withdrawal i.e palpitations, tremors, psychotic episodes
What are synthetic cannabinoids(spice, herbal incense, pot pourri, room oduriser)
- dried plant matter which has been sprayed with a chemical designed to mimic THC, however effects are much stronger / intense.
What do synthetic cannabinoids look like
- dried leafy material, similar to Cannabis but smells more chemically
How are synthetic cannabinoids used
- Smoked with tobacco in a joint, or in a pipe, bong.
Cannabinoid oil can be smoked in a vaporizer. Class B.
Immediate effects of synthetic cannabinoids
- Some can make youfeel happy & relaxed. Some peoplemay get the giggles, feel hunger pangs & become very talkative. Others get more drowsy. Mood / perception can change & concentration / co-ordination may become difficult.
Risks and harms of synthetic cannabinoids
- Higher THC (panic, paranoia, M.H issues) & Lower CBD (anxiety-reducing, relaxing). Associated with triggering psychotic symptoms even in those who have never experienced MH issues before.
What is mephedrone(meow, m-cat, drone, meph)
stimulant drug belonging to the chemical family of the ‘cathinones’. (A group of drugs related to amphetamine, compounds likespeedand ecstasy)
What does mephedrone look like
- White powder, shards / crystals. Class B.
How is mephedrone used
- Snorted, injected, Swallowed, up the bum
Immediate effects of mephedrone
- Euphoria, alertness and feelings of affection towards the people around you. Supressed appetite. Feelings of anxiety and paranoia.
Risks and harms of mephedrone
- Can overstimulate heart, circulation & nervous system, with risk of fits. Strong desire to re-dose. Causes nasal damage if snorted. Risk of BBV’s, STI’s, injecting wounds if new to injecting.
What is GHB/GBL(geebs, G, gina)
- Industrial solvent, used in mechanics, central nervous system depressant. GBL is converted to GHB shortly after entering the body.
What does GHB look like
- transparent liquid with a salty taste. Class B.
How is GHB used
- swallowed with water or juice
Immediate effects of GHB
- feelings of euphoria, reduced inhibitions & drowsiness. Effects start after about 10 minutes to an hour and can last for up to seven hours or so.
Risks and harms of GHB
- physically addictive, easy to overdose due to dose sensitivity (0.5 – 2ml). Linked to sexual assaults (date rape). Extremely dangerous when mixed with alcohol or other depressants.
What are NPS
- synthetic chemicals manufactured to mimic effects of common illegal drugs or prescribed drugs, now classified under the Psychoactive Substances Act
What do NPS look like
- includes GBL, Mephedrone & what were ‘Legal Highs’
How are NPS used
- Snorted, injected, smoked, gummed, swallowed,
up the bum – depends on what type!
Immediate effects of NPS
- VARIOUS – 100’s of different combinations, all with different chemical mixtures and strengths.
Risks and harms of NPS
- little long term effects known. Highly variable effects ranging from seizures, sudden death, coma, rashes, vomiting, mental health problems, addiction…
