Introduction to Substance Abuse

Question 1

What is a drug?

Answer 1

A medicine or other substance which as a physiological effect when ingested or otherwise introduced into the body

Question 2

What age group are at higher risk of drug misuse?

Answer 2

16-24 y/o

Question 3

Define substance use disorders:

Answer 3

“a cluster of cognitive, behavioural and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems”

Question 4

What is an addiction?

Answer 4

chronic, primary, neurobiological condition influence by genetic, psychosocial and environmental factors

Question 5

Give some examples of risk factors for drug misuse & addiction:

Answer 5

• men twice as likely to have drug problems
• home and family, friends and acquaintances who use drugs
• stress
• availability of drugs
• method of drug administration
• coexisting mental problems
• peer pressure
• early exposure to drugs

Question 6

Discuss the pattern of addiction associated with opioids:

Answer 6

• intense initial intoxication
• development of profound tolerance
• escalation in intake
• profound dysphoria, physical discomfort, and somatic withdrawal signs during abstinence

Question 7

How can drugs affect neurotransmitters?

Answer 7

The use of drugs can produce:
- increased levels of dopamine (euphoria)
- decreased levels of serotonin (decreased levels of contentment)

Question 8

How does prolonged exposure of drugs alter the brain?

Answer 8

Results in addiction through the rewards pathway
- chronic exposure reduces the sensitivity of the brain to reward systems

Question 9

Discuss the different behaviour classifications of drugs:

Answer 9

• stimulants
• opioids
• sedative hypnotics
• antipsychotics
• antidepressants
• psychedelic

Question 10

What % of healthcare professionals misuse drugs or alcohol?

Answer 10

10-15%

Question 11

What risks are associated with illicit IV drug use?

Answer 11

• increased risk of infections
• sexually shared infections
• cellulitis
• abscess
• thrombophlebitis
• DVT
• embolism

Question 12

What term do we use nowadays instead of IV drug users?

Answer 12

People who inject drugs (PWID)

Question 13

How do STIs relate to drug users?

Answer 13

• high rates of STIs seen among DUs
• more prone to indulge in frequent high-risk sexual activity

Question 14

What is the most common BBV transmitted by IV drug users/people who inject drugs?

Answer 14

Hepatitis C

Question 15

What are some side effects of cannabis?

Answer 15

• euphoria
• slowed thinking & reaction time
• confusion
• impaired balance & coordination
• cough
• increased HR
• anxiety
• panic
• tolerance

Question 16

Give some examples of signs of addictions:

Answer 16

• loss of reliability
• mood changes
• impaired driving
• worsening personal & professional isolation
• excessive amounts of time spent near a drug supply

Question 17

How does stress present physically?

Answer 17

• increased heart rate & blood pressure
• palpitations
• increased muscle tensions
• headaches
• jaw ache
• insomnia

Question 18

How might you recognise substance misuse in your patients?

Answer 18

• loss of reliability
• mood & behaviour changes
• impaired ability to drive
• requesting specific drugs
• tremors
• constricted or dilated pupils
• bruising, puncture marks, scare or pigmentation over veins

Question 19

Give examples of barriers to accessing dental services:

Answer 19

• professionals negative perception of these people
• low priority of oral health compared with drug use
• fear of dentists
• self medication
• chaotic lifestyles
• fear judgement
• poor attendance & compliance

Question 20

Why can drugs pose an issue to proper consent?

Answer 20

• capacity considerations
• treatment may need to be postponed if pt is under influence of drugs/alcohol

Question 21

What issues around LA are associated with opioid users?

Answer 21

LA resistance

Question 22

An alcoholic patient present to your clinic & requires treatment with LA. Why must you be careful in your LA selection?

Answer 22

Avoid using LA that is metabolised in the liver / keep doses to a minimum
- even 2 cartridges can trigger CNS toxicity signs in severe liver disease

Question 23

What are examples of general dental implications of substance misuse?

Answer 23

• rampant caries
• periodontal disease including necrotising conditions
• NCTSL
• masseteric hypertrophy
• hyposalivation (opiates & cannabis)
• poor OH
• poor denture hygiene
• opportunistic infections
• trauma
• oral cancer & mucosal lesions

Question 24

What are some risk factors for development of necrotising periodontal diseases?

Answer 24

• HIV
• malnourishment
• extreme living conditions
• smokers
• psychosocially stressed

Question 25

Why does LA resistance occur sometimes?

Answer 25

Seen in opioid users

Question 26

How does LA interact with cannabis?

Answer 26

LA with adrenaline can prolong acute tachycardia

Question 27

How does LA interact with alcohol?

Answer 27

Care with LA that is metabolised in the liver (keep dosages to a minimum)

Question 28

What are some general dental implications of substance misuse?

Answer 28

• rampant caries
• periodontal diseases
• NCTSL
• masseteric hypertrophy
• hyposalivation (espeically opiates and cannabis)
• poor OH
• oral cancer and mucosal lesions

Question 29

Why is oral cancer more common in those with substance abuse disorders?

Answer 29

Shared risk factors such as:
- smoking
- alcohol
- direct application of drug to mucosa
- poor diet and immune status
- low socioeconomic status

Question 30

What is some dental advice you may give to methadone users?

Answer 30

• use a straw
• drink water after consumption
• dont brush teeth immediately after
• engage with dental services
• enhanced prevention