Illicit substance misuse symposium Flashcards
Describe hazardous use
Drug use that is likely to lead to harm.
Describe harmful use
Drug use which causes damage to health
physical or
mental
Describe dependence
Pattern of ongoing use that is hard to stop
List the components of dependence
Withdrawal Compulsion Salience Persistence despite evidence of harm Impaired control Tolerance
Describe the clinical presentation of someone with dependance
Withdrawal (negative effects)
Sober
Intoxication (negative effects)
List other adverse effects of dependence
Excessive chronic use
Idiosyncratic effects
After effects or delayed effects
E.g. flashbacks
What do physical complications relate to?
Specific drug effects
Contaminants
Method of use
Lifestyle
How many deaths a year are due to drug misuse?
1500
What is the mortality per year due to drug misuse?
1-2%
List some complications of drug misuse
Overdose cellulitis abscesses, thrombophlebitis arterial occlusion septicaemia endocarditis TB respiratory infections Hepatitis C (and B) HIV
What percentage of attendances to A&E in the past 2 years have been due to substance misuse?
54%
List the psychiatric complications of substance misuse?
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
List social complications of substance misuse
family, children, society
List the occupational complications of substance misuse
Number “mostly unemployed” (NTORs)
Over 75%
How much does street heroin currently cost?
£40-60 gram
How many of those receiving treatment for a drug problem were parents or lived with children?
Just over 50%
List some medical complications of cocaine use
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
List some 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.
List the signs of opiate intoxication
Euphoria / relaxation Feeling of well being Constricted pupils Drowsiness Slurred speech Poor attention and concentration
Describe the symptoms of 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 Irritability Insomnia Low-grade fever Increased pulse rate Increased blood pressure Increased respiratory rate Restlessness Abdominal cramps Nausea and vomiting Diarrhoea Weakness Weight loss
Why do people die from illicit drug use?
Overdose - suicidal or accidental
Medical complications
Describe the triad of symptoms of opiate overdose
Unconsciousness
Respiratory depression
Pin point pupils
How do you treat an opiate overdose?
Establish airway
Ventilate (100% O2)
Naloxone IV/IM
Repeat 2-3 mins
Harm reduction …
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
When to refer to specialist services?
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?
How are drugs classified?
Depressants
Stimulants
Hallucinogens
List the risks and harm 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
