lecture 22 - the pharmacist in substance misuse Flashcards
define tolerance, dependance and addiction
tolerance is reduced drug effect with repeated use, requiring high doses for the same effect
dependance is chronic use leading to withdrawal symptoms upon discontinuation
addiction is compulsive, repetitive drug use at potentially harmful doses
What are the ICD-10 / DSM-5 criteria for substance dependence?
Diagnosis requires three or more of the following within 12 months:
Strong craving
Loss of control over use
Withdrawal symptoms
Tolerance
Neglect of other activities
Continued use despite harm
If only 1 or 2 are present, it is classified as substance misuse.
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 a substance sue disorder and a mental health disorder for example, depression, anxiety or schizophrenia
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 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 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 is polysubstance use, and why is it dangerous?
Using multiple substances together (e.g., opioids & benzodiazepines, stimulants & alcohol), leading to unpredictable effects, overdose risk, and increased harm.
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?
Cognitive Behavioral Therapy (CBT)
Motivational Interviewing
Acupuncture
Occupational Therapy
Brief interventions
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 is the role of Injecting Equipment Provision (IEP)?
Previously called Needle Exchange.
Provides clean injecting equipment per injection.
Reduces harm, blood-borne virus transmission, and infections.
Offers safe disposal and harm reduction advice.
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)
Foil (for smoking drugs)
What are emerging drug trends in substance misuse?
Synthetic opioids (e.g., fentanyls, nitazenes)
New benzodiazepines
Constant changes in illicit drug supply
What is disulfiram, and why must alcohol be avoided when taking it?
Used for alcohol dependence treatment.
Causes severe reactions (flushing, nausea, vomiting, palpitations, death) when alcohol is consumed.
Even small amounts in aftershave, deodorants, or cooked foods can trigger reactions.
