Illicit substance misuse symposium

Question 1

Describe hazardous use

Answer 1

Drug use that is likely to lead to harm.

Question 2

Describe harmful use

Answer 2

Drug use which causes damage to health
physical or
mental

Question 3

Describe dependence

Answer 3

Pattern of ongoing use that is hard to stop

Question 4

List the components of dependence

Answer 4

Withdrawal
Compulsion
Salience
Persistence despite evidence of harm
Impaired control
Tolerance

Question 5

Describe the clinical presentation of someone with dependance

Answer 5

Withdrawal (negative effects)
Sober
Intoxication (negative effects)

Question 6

List other adverse effects of dependence

Answer 6

Excessive chronic use
Idiosyncratic effects
After effects or delayed effects
E.g. flashbacks

Question 7

What do physical complications relate to?

Answer 7

Specific drug effects
Contaminants
Method of use
Lifestyle

Question 8

How many deaths a year are due to drug misuse?

Answer 8

1500

Question 9

What is the mortality per year due to drug misuse?

Answer 9

1-2%

Question 10

List some complications of drug misuse

Answer 10

Overdose
cellulitis
abscesses, thrombophlebitis
arterial occlusion
septicaemia
endocarditis
TB
respiratory infections
Hepatitis C (and B)
HIV

Question 11

What percentage of attendances to A&E in the past 2 years have been due to substance misuse?

Answer 11

54%

Question 12

List the psychiatric complications of substance misuse?

Answer 12

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

Question 13

List social complications of substance misuse

Answer 13

family, children, society

Question 14

List the occupational complications of substance misuse

Answer 14

Number “mostly unemployed” (NTORs)

Over 75%

Question 15

How much does street heroin currently cost?

Answer 15

£40-60 gram

Question 16

How many of those receiving treatment for a drug problem were parents or lived with children?

Answer 16

Just over 50%

Question 17

List some medical complications of cocaine use

Answer 17

Cardiovascular - BP increases, MI, arrhythmias & sudden death

CNS - CVA’s, seizures (lowers threshold)

Infective - Abscesses, cellulitis, hepatitis, SABE, septicaemia, HIV

Respiratory - Chest pain, dyspnoea, lung damage, “crack lung”, respiratory failure

General - weight loss
Obstetric - Miscarriage, premature labour

Question 18

List some psychological complications of cocaine use

Answer 18

Crash (Withdrawal) - Irritability, restlessness, fatigue, hypersomnia, hyperphagia

Anxiety especially panic

Depression / Mania

Anti-social behaviour

Paranoid Psychosis

Tactile / visual hallucinations. “Cocaine bug ”

Repetitive behaviour.

Question 19

List the signs of opiate intoxication

Answer 19

Euphoria / relaxation
Feeling of well being
Constricted pupils
Drowsiness
Slurred speech
Poor attention and concentration

Question 20

Describe the symptoms of opiate abstinence syndrome

Answer 20

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
Irritability
Insomnia
Low-grade fever
Increased pulse rate
Increased blood pressure
Increased respiratory rate
Restlessness
Abdominal cramps
Nausea and vomiting
Diarrhoea
Weakness
Weight loss

Question 21

Why do people die from illicit drug use?

Answer 21

Overdose - suicidal or accidental

Medical complications

Question 22

Describe the triad of symptoms of opiate overdose

Answer 22

Unconsciousness
Respiratory depression
Pin point pupils

Question 23

How do you treat an opiate overdose?

Answer 23

Establish airway
Ventilate (100% O2)
Naloxone IV/IM
Repeat 2-3 mins

Question 24

Harm reduction …

Answer 24

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

Question 25

When to refer to specialist services?

Answer 25

Mostly self referral however when:
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?

Question 26

How are drugs classified?

Answer 26

Depressants
Stimulants
Hallucinogens

Question 27

List the risks and harm of heroin

Answer 27

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