lecture 22 - the pharmacist in substance misuse Flashcards
define tolerance, dependance and addiction
tolerance is reduced effect of the drug or requiring higher doses of the drug to get the same response level
dependance is when there is chronic use of a drug leading to withdrawal symptoms upon sudden discontinuation or rapid dose reduction
addiction is when there is compulsive and receptive use of a drug at potentially harmful doses. tolerance and physical dependance may develop as well
What are the ICD-10 / DSM-5 criteria for substance dependence?
Diagnosis of dependence requires three or more of the following within 12 months (if only 1 is applicable this is misuse)
strong desire or compulsion to sue the substance –> neglect in other interests due to substance misuse –> tolerance
difficulties in controlling the use of substances–> repetitive use despite harmful consequences –> withdrawal symptoms
What are the Medication-Assisted Treatment (MAT) Standards?
- Same-day access to MAT.
- Informed choice on medication and dose.
- High-risk individuals proactively identified for MAT.
- Evidence-based harm reduction at MAT delivery.
- Support to remain in treatment as long as needed.
- Psychologically informed system with social support.
- MAT shared with Primary Care.
- Access to advocacy, housing, welfare support.
- Integrated mental health and substance use care.
- Trauma-informed care.
Name common pharmacological treatments for substance misuse.
Opioids: Methadone, Buprenorphine, Lofexidine, Naltrexone, Naloxone.
Benzodiazepine misuse: Diazepam.
Alcohol: Disulfiram, Acamprosate, Naltrexone, Nalmefene, Chlordiazepoxide, Diazepam, Thiamine, Vitamin B.
what is dual diagnosis?
dual diagnosis is coexistence of one or more mental disorder in individuals who also satisfy diagnostic criteria for substance use or vice vera
Name some common health comorbidities in substance misuse patients.
Mental health issues (Depression, Anxiety)
Poor diet & self-neglect
Dental health issues
Aging patient cohort
Social isolation & poverty
Discrimination & criminality
what is the effect of alcohol misuse?
alcohol misuse can cause vitamin deficiency
malnutrition and malabsorption of vitamin B
can progress to Korsakofs Psychosis/ Wernickes Encephalopathy and cause aggression
What is Korsakoff’s Psychosis/Wernicke’s Encephalopathy, and how is it related to substance misuse?
Severe neurological disorder due to vitamin B deficiency from chronic alcohol misuse.
Symptoms: Memory loss, confusion, aggression, lack of coordination.
what are image enhancing drugs ?
image enhancing drugs include steroids or tanning agents. they can cause aggression, depression, diabetic complications, liver disorders and unknown long term effects
what are risks and common patterns associated with polysubstance use ?
known increased risk factor for drug related death.
people may use stimulates followed by benzodiazepines to reduce hallucinogens and stimulant effects
Opioid use followed by benzodiazepines and/or alcohol
multiple effects that have dangers and are unpredictable
What are common psychological and physical effects of substance misuse?
Opioids: Anxiety, depression, analgesic misuse.
Benzodiazepines: Memory loss, aggression, short-term anxiety relief.
Stimulants/Hallucinogens: Mania, depression, psychosis, nightmares.
Image-enhancing drugs: Liver disorders, diabetes, aggression.
Cannabinoids: Anxiety, paranoia, psychosis.
What are some general health risks associated with substance misuse?
Infections (Anthrax, Botulism, Blood-borne viruses)
Liver damage
Cardiomyopathy (heart enlargement)
Premature aging
Suicidality (increased risk of self-harm)
What alternative therapies can help treat substance misuse?
psychology
psychiatry
cognitive behavioural therapy
motivational interviewing
occupational therapy
acupuncture
What are the drug interactions that pharmacists should be aware of in substance misuse treatment?
Methadone: QtC prolongation (risk of torsades de pointes).
CNS depressants & sedatives: Respiratory depression.
Antipsychotics & Hepatitis C treatment: Enzyme-inducing effects.
Metronidazole & Alcohol: Severe reaction
what precautions must be taken by patients taking disulfiram ?
patients should avoid all alcohol including in hidden sources such as aftershave/ perfumes, deodorants and hair dye. avoid high strength caffeine drinks and excessive vitamin C. care need to be taken with food cooked with alcohol
what are the aims of injecting equipment provision ?
provision of clean injection equipment
reducing injecting related harm
reducing BBV transmission
resign viral pool
disposal of used apparatus
providing harm reduction messages and warnings
sign posting services
What injecting equipment can be supplied under IEP
Needle & barrel – for injection
Spoon (cooker) – for drug preparation
Filter – removes particles
Alcohol wipe – cleans injection site
Citric acid – helps dissolve heroin
Sharps bin – for used equipment disposal
Sterile water – for injection preparation
What items cannot be supplied under IEP?
Tourniquets (to raise veins)
What are emerging drug trends in substance misuse?
Synthetic opioids (e.g., fentanyls, nitazenes)
New benzodiazepines
Constant changes in illicit drug supply
