Intro Substance Use disorder Dr. Thomason

Question 1

What are the 3 waves of the overdose epidemic?

Answer 1

Wave 1: rise in prescription opioid overdose deaths 1999

Wave 1: rise in heroin overdose deaths 2010

Wave 3: rise in synthetic opioid overdose deaths 2013

Question 2

Question to ask to get a proper Substance use history?

Answer 2

When did you start using these drugs?
How much, what strength?
Are they prescribed? From the street?
What have you used in the past?
How are using it? Swallow, snoring, injecting, rectally?
Have you ever overdosed? (they could be around people who use -> they may be at higher risk of overdosing themselves
Have you had naloxone training?

Question 3

What substance to ask a patient about on the first visit?

Answer 3

Caffeine
Alcohol
Nicotine

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Amphetamines
Cocaine
Opioids -> ask for Heroin, fentanyl and prescription
Hallucinogens: mushrooms, PCP, LSD
THC: dela-8 and delta-10

Question 4

Patients past history: use of drugs

Answer 4

-in the past 6 months, have you taken any medications to help you calm down, keep from getting nervous or upset, raise your spirits, make you feel better

-that help you sleep? have used alcohol for sleep?

-that help you with a drug or alcohol problem?

-that help for nervous stomach?

• to give you more energy or to cut down your
  appetite? -> stimulants

-also ask about OTCs and may use alcohol screening tool AUDIT

Question 5

What are approaches to conduct harm reduction of substance use?

Answer 5

-Safe syringe use
-fentanyl test strips
-naloxone (Narcan) training

Question 6

Who should get Narcan?

Answer 6

-patients who are on prescribed opioid pain relievers

-treated for SUD (methadone or buprenorphine)

-people who have loved ones who have an opioid use disorder

Question 7

DSM-5 Criteria

Answer 7

2-3 symptoms: mild SUD

4-5 symptoms: moderate SUD

6 or more symptoms: severe SUD