Introduction to Substance Abuse Flashcards
What is a drug?
A medicine or other substance which as a physiological effect when ingested or otherwise introduced into the body
What age group are at higher risk of drug misuse?
16-24 y/o
Define substance use disorders:
“a cluster of cognitive, behavioural and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems”
What is an addiction?
chronic, primary, neurobiological condition influence by genetic, psychosocial and environmental factors
Give some examples of risk factors for drug misuse & addiction:
- 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
Discuss the pattern of addiction associated with opioids:
- intense initial intoxication
- development of profound tolerance
- escalation in intake
- profound dysphoria, physical discomfort, and somatic withdrawal signs during abstinence
How can drugs affect neurotransmitters?
The use of drugs can produce:
- increased levels of dopamine (euphoria)
- decreased levels of serotonin (decreased levels of contentment)
How does prolonged exposure of drugs alter the brain?
Results in addiction through the rewards pathway
- chronic exposure reduces the sensitivity of the brain to reward systems
Discuss the different behaviour classifications of drugs:
- stimulants
- opioids
- sedative hypnotics
- antipsychotics
- antidepressants
- psychedelic
What % of healthcare professionals misuse drugs or alcohol?
10-15%
What risks are associated with illicit IV drug use?
- increased risk of infections
- sexually shared infections
- cellulitis
- abscess
- thrombophlebitis
- DVT
- embolism
What term do we use nowadays instead of IV drug users?
People who inject drugs (PWID)
How do STIs relate to drug users?
- high rates of STIs seen among DUs
- more prone to indulge in frequent high-risk sexual activity
What is the most common BBV transmitted by IV drug users/people who inject drugs?
Hepatitis C
What are some side effects of cannabis?
- euphoria
- slowed thinking & reaction time
- confusion
- impaired balance & coordination
- cough
- increased HR
- anxiety
- panic
- tolerance
Give some examples of signs of addictions:
- loss of reliability
- mood changes
- impaired driving
- worsening personal & professional isolation
- excessive amounts of time spent near a drug supply
How does stress present physically?
- increased heart rate & blood pressure
- palpitations
- increased muscle tensions
- headaches
- jaw ache
- insomnia
How might you recognise substance misuse in your patients?
- 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
Give examples of barriers to accessing dental services:
- 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
Why can drugs pose an issue to proper consent?
- capacity considerations
- treatment may need to be postponed if pt is under influence of drugs/alcohol
What issues around LA are associated with opioid users?
LA resistance
An alcoholic patient present to your clinic & requires treatment with LA. Why must you be careful in your LA selection?
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
What are examples of general dental implications of substance misuse?
- 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
What are some risk factors for development of necrotising periodontal diseases?
- HIV
- malnourishment
- extreme living conditions
- smokers
- psychosocially stressed
Why does LA resistance occur sometimes?
Seen in opioid users
How does LA interact with cannabis?
LA with adrenaline can prolong acute tachycardia
How does LA interact with alcohol?
Care with LA that is metabolised in the liver (keep dosages to a minimum)
What are some general dental implications of substance misuse?
- rampant caries
- periodontal diseases
- NCTSL
- masseteric hypertrophy
- hyposalivation (espeically opiates and cannabis)
- poor OH
- oral cancer and mucosal lesions
Why is oral cancer more common in those with substance abuse disorders?
Shared risk factors such as:
- smoking
- alcohol
- direct application of drug to mucosa
- poor diet and immune status
- low socioeconomic status
What is some dental advice you may give to methadone users?
- use a straw
- drink water after consumption
- dont brush teeth immediately after
- engage with dental services
- enhanced prevention
