Liam (Drug Misuse and Abuse) Flashcards

1
Q

Year 1 recap

A

Human Medicine Regulations and POMs
- Requirements for prescriptions and supply of medicines and POMs

Misuse of Drugs Act and Regulations
- Different schedules for CDs
- Rules about supply of CDs
- Prescription requirements for CDs
- Records for the supply and recite of CDs
- Safe custody of CDs

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2
Q

History of drugs of abuse and legislation

A
  • Before 20th century drugs like heroin and cocaine were freely available for many things such as toothpaste and coughs
  • There was international clampdown on drug misuse and abuse in the 1950s
  • Legislation was introduced in 1960s leading to the Misuse of Drugs act 1971
    • Total prohibition on the possession, supply, manufacture, import or export of CDs except:
      - As allowed by the Misuse of Dugs Regulations
      - Under a license from the Secretary of State for the Home Office
    • Established the Advisory Council on the Misuse of Drugs (ACMD)
    • Advises ministers on how different drugs should be restricted and how to treat the problem of drug abuse and misuse in society
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3
Q

Misuse of Drugs Act 1971

A
  • Classifies CDs in classes (A, B, and C) based on penalties duo possession, supply, or manufacture
  • Classifies CDs in schedules (1-5) based on rules for legal supply and possession
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4
Q

Prevalence of drug misuse and abuse

A
  • High
  • 8% of people aged 16-59 had taken an illegal drug in the past year and 4% in the past month
  • 18% of people aged 16-24 had taken an illegal drug in the past year and 9% in the past month
  • 35% of adults have taken an illegal drug at some point in their lives
  • 3% were defined as frequent users- more than once a month on average in the past year
  • Use of a class drug was around 10x higher in those who had visited a nightclub at least 4 times in the past month
  • 5% of 15 year olds had used cannabis in the past month
  • Men are more likely to have used illicit drugs than women
  • Death rate has increased each year from 2014
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5
Q

Risk factors

A

Environment
- Chaotic home life
- Abuse
- Parents use of illicit drugs and their attitudes to drugs
- Poor influences
- Peer influence
- Community attitude
- Poor school achievement

Biology/genes
- Genetic predisposition to become addicted
- Gender (men more likely to abuse drugs than women)
- Mental disorders

Cost
Availability
Effect of drug itself
Route of administration
Homelessness
Poor working conditions
Unemployment

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6
Q

Legal highs

A

New Psychoactive Substances (NPS’s)
- Mephedrone in the 2000s
- Some local enforcement followed by new national action
- Issues:
- Substances are not controlled under MDA as they are not classified as a drug
- Two ways to address the issue
- Psychoactive Substances Act 2016
- Temporary Class Drug Orders- classes the chemical as a drug for the purpose of the misuse of drug act even though it hasn’t gone through any regulation processes of drugs

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7
Q

Difference between drug misuse and drug abuse

A

Misuse- implies the use of the drug in an inappropriate but maybe well intentioned way. e.g. laxatives used too much, nasal decongestants overuse, painkillers used for too long

Abuse- implies deliberate use of the drug outside of its license to achieve an inappropriate aim.

The main difference is intent.
Terms are used interchangeable but are not the same.
Substance abuse and misuse is a broader term and includes non-drug substances

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8
Q

Addiction, dependance, and tolerance

A

Addiction- defined as not having control over doing, taking, or using something to the point where it could be harmful to you. e.g. gambling, sex, gaming, drugs

Dependance- occurs when the body relies on a drug physically, or psychologically
- Physical- body adapts to the presence of a drug and in its absence there are withdrawal symptoms
- Psychological- based on our need for the drug but no physical dependance on it. e.g. sleep aids which contain anti-histamine and cause drowsiness but do not cause changes to the body to create physical dependance. People believe they need the drug and create a psychosomatic reaction to not having them
- Tolerance- a persons diminished response to a drug which occurs when the drug is used repeatedly and the body adapts to the continues presence of the drug e.g. opiates

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9
Q

What can be abused?

A

Substances
- Alcohol
- Tobacco
- Nicotine
- Solvents
- Nitrous oxide

OTC medicines
- Codeine
- Pain killers
- Sleeping aids
- Laxatives
- Antidiarrhoeals
- Proplus (caffeine tablets)
- Vicks Vaporub

Rx medicines
- Pain killers
- Opiates
- Methadone
- Anxiolytics
- Antidepressants
- Sleeping tablets
- Steroids

Illicit drugs
- Heroin
- Other opiates
- Cocaine
- Crystal meth
- amphetamines
- Rohypnol (sleeping pill)
- MDMA
- Marijuana
- GHB (general anaesthetic)
- LSD (acts on CNS)
- Anabolic steroids

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10
Q

Aims of treatment of substance misuse

A
  • Reducing harm- to individual and community
  • Discontinuation of the substance use- detoxify patient and help stop using substance
  • Address social issues- substance misusers often have a number of social issues such as family issues, housing, homelessness, unemployment, theft
  • Reintegration into societal role- help them in their role as a parent, partner, employee, etc
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11
Q

Treatment of substance misuse

A

Detoxification
- Substitution with sufficient appropriate drug to enable switch from illicit use
- Followed by gradual reduction of drug until not physically dependant

Stabilisation
- Low and steady level use of the drug until they are ready to stop

Maintenance
- Longer term management using drug substitute

  • Rehabilitation and re-integration
  • In all cases a vital part of treatment
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12
Q

Services involved in drug misuse treatment

A
  • Childcare
  • Vocational
  • Mental health
  • Medical
  • Educational
  • HIV/AIDS
  • Legal
  • Financial
  • Housing/transportation
  • Family
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13
Q

Challenges of drug misuse therapy

A
  • Patients often remain in a community of peers who are drug using
  • Relapse is common- withdraw over 3-6 months
  • Try to remove patient from temptation in environment
  • Side effects- constipation, sweating
  • Only partly successful
  • Illicit use/sales of methadone- people get it on prescription as substitute for drugs then sell it
  • Concomitant use of illicit substances is common- e.g. use methadone as a baseline and still go for a hit from other drugs. Why it is important for other services to get involved to get a holistic approach to the situation
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14
Q

Services provided in community pharmacies

A
  • Dispeinsing
  • Instalment dispensing- for drugs being used as a substitute for illici drugs
  • Supervised consumption
  • Needle exchange
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15
Q

Why we provide these services

A
  • Reduces street diversion- reduces amount of drugs going onto the street
  • Aids compliance- helps patient to regularly take their medication
    0 Prevent harm to others- patients are less likely to inject whilst using services
  • Improves control and safety
  • Daily contact with a healthcare professional
  • Opportunity for fried advice and signposting
  • Early intervention if things go wrong
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16
Q

Prescription for instalment dispensing

A

FP10MDA
Prescribing information on left hand side:
- Patient name and address
- Doctor name and address
- Prescriber signature
- Date
- Normal CD requirements
- Quantity in words and figures
- Form and name of product
- Instructions for use
- Size of instalments and when to supply them
- Instructions for days when the pharmacy is closed
- Instructions about managing missed doses

Endorsing the FP10MDA on the right hand side:
- Endorse to record doses
- Not a legal requirement but an administrative requirement for payment for individual dispensing
- Date, what was provided, quantity, initials

Recording supply:
- Record is made when the patient collects the dose
- Date
- Name and address of patient
- Prescriber name and details

17
Q

Supervised consumption

A

Enhanced service contracted for by community pharmacies from the NHS or county councils

Service arrangements aim to be a 3-way partnership between the prescriber, pharmacy, and client

Aim of enhanced service are:
- To contribute to the clinical care of patients undergoing opiate substitution therapy
- To ensure the prescribed medication is taken as directed by the patient for whom it is intended
- To monitor the wellbeing of the patient while self-administering prescribed medication
- To reduce the incidence of diversion of medication- can ask patient to drink water afterwards to make sure they are not holding it in their mouths to spit out later
- To reduce accidental ingestion of prescribed medication- put it down at home and children/someone else gets hold of it
- To provide regular contact with a healthcare professional able to feedback progress or concerns to the drug treatment provider

Report to prescriber or drug worker if:
- Patient failing to pick up a third consecutive dose
- Patient showing intermittent contact, with regularly missed doses
- Patient presenting to pharmacy in an intoxicated state
- Failure of the patient to comply with directed self-administration of medication
- Concerns regarding the patients physical or mental health
- Concerns regarding risk, including safeguarding
- Inappropriate behaviour by the patient or associates
- Problems with the completion of the prescription

18
Q

Pharmacy’s role in needle exchange

A
  • Provision of sterile injecting equipment- reducing harm
  • Disposal of used injecting equipment- reducing harm to community and individual
  • Provision of advice and information on safer injecting and safer drug use
  • Provision of advice and information on injecting injuries and wound care
  • Advice and information on testing for blood borne viruses
  • Advice and information on safer sex
  • General health advice
19
Q

Provision of injecting equipment

A

Paraphernalia that is legal to supply
- Sharps containers
- Syringes
- Needles
- Cooking pans so people can heat up their heroin
- Vitamin C and citric acid sachets- helps with solubility of heroin and removes some impurities that street heroin may contain
- Wipes to clean injection area
- Foil

Packs can be provided that contain a bundle of equipment. What the pack contains depends on what type of injections is taking place
- For IV use/injecting into surface veins. Suitable for opiate/amphetamine use
- For injecting into deeper veins (femoral/groin)
- For IM injecting. Suitable for steroid injectors

20
Q

Medical complications of injecting

A
  • Soft tissue infections- not clean
  • Septicaemia and endocarditis- systemic result from soft tissue injuries
  • Pulmonary complications- air bubbles caught in the blood
  • Musculoskeletal problems
  • Candidiasis and oral health
  • Water borne infections (Hep A)
  • Blood borne viruses (Hep B and C, HIV)
  • Bacterial infections (Clostridia, strep infections)
21
Q

Other legislation relevant to drug misuse or abuse

A
  • Cigarette lighter refill (safety) Regulations 1999
  • Intoxicating Substances (supply) Act 1985
  • Children and Young Persons (Protection from tobacco) Act 1991
  • Customs and Excise Management Act 1979
  • Drug Traffickers Offences Act 1994
  • Crime and Disorder Act 1998