Public health week 5 Flashcards
Give 4 key features of drug addiction
craving tolerance compulsive drug-seeking behaviour physiological withdrawal state little interest in other activities
What philosophy is used to guide management of drug users?
Give some core principles of it.
Harm reduction philosophy:
- Accepts that drug use is part of our world
- work to minimize its harmful effects
- understands that some ways of using drugs are clearly safer than others
- non-judgmental, non-coercive provision of services to drug users o assist them in reducing harm.
- Ensures that drug users have a voice in the creation of programs and policies designed to serve them.
- Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to support each other.
- Recognizes that the realities of social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
- Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use.
Physical effects of drug use
Complications of injecting (DVT, abscesses, SBE, blood-borne viruses) Overdose (respiratory depression) Poor pregnancy outcomes Side effects of opiates (constipation) Malnutrition
Social effects of drug use
Effects of poverty
Effects on families
Drive to criminality, Imprisonment
Social exclusion
Negative psychological effects of drug use
Fear of withdrawal
Craving
Guilt
Depression and anxiety
Heroin:
a) Administration
b) ‘Positive’ effects
c) Adverse effects
a) Routes of administration: (powder), smoking/chasing, snorting, oral , IV, subcutaneous, IM, rectal
b) Effects: euphoria, intense relaxation, miosis, drowsiness
c) Adverse effects: dependence and withdrawal symptoms, physical complications (nausea, itching, sweating, constipation), overdose, IVDU risks
Cocaine/crack
a) Admin
b) Mode of action
c) ‘Positive’ effects
d) Adverse effects
a) Routes of administration (coca leaves, powder, crack)
oral, snorting, smoking, iv
b) Mode of action:
- Blocks reuptake of mood enhancing neurotransmitters at the synapse (serotonin, dopamine)
- Intense pleasurable sensation
- Reinforcement leading to further use
- Depletion at secretory neurone
- Anxiety, panic, adrenaline secretion, ‘wired’
c) Effects:
- confidence, well-being, euphoria, impulsivity, increased energy, alertness
- impaired judgement, decreased need for sleep
may produce anxiety, HTN, arrhythmias, subsequent “crash”-dysphoria
chronic effects-depression, panic, paranoia, psychosis, damaged nasal septum, CVA, respiratory problems
Give 4 aims of treatment for drug users
To reduce harm to user, family and society
To improve health
To stabilise lifestyle and reduce the amount of illicit drug use
To reduce crime
Treatment approaches for drug users
Harm reduction (especially for non-opiate users)
Detoxification (lofexidine, buprenorphine)
Maintenance: methadone (full agonist), buprenorphine (partial agonist/antagonist)
Relapse prevention (naltrexone)
Psychological interventions
Alternative therapies
Referral for allied problems (Hep C, STDs etc)
a) Give 4 advantages of opiate maintenance treatment vs heroin use
b) Give 2 commonly used substitutes
a) Reduces mortality very significantly
Reduces drug-related morbidity
Reduces crime
Reduces risk taking behaviour and spread of blood borne viruses
b) Methadone and buprenorphine
What should be offered for a newly presenting drug user? (screening, tests, advice, signposting, etc.)
SEX-C SHIT
Sexual health screening
EXchange needles
Contraception
Signposting (additional help → counselling, stop-services)
Health check (full)
Immunisations (Hep B, C, A, et.c)
Treatment (detoxification, maintenance, relapse prevention, withdrawal relief, etc.)
Harm reduction: what can be offered to…
a) Prevent deaths
b) Prevent blood borne virus transmission
c) Who can you refer patients to?
Action to prevent deaths (2nd highest cause of death in young males):
- not injecting or injecting more safely
- not mixing respiratory depressants
- not using drugs alone
- reducing amount taken after intervals where tolerance is lost
- call an ambulance if necessary
Action to prevent blood borne virus transmission
- not sharing needles etc
- safer sex (condoms)
- provision of Hepatitis A and B vaccination
- Blood borne virus screening including Hep C
Referral where appropriate
- specialist drug services
- voluntary sector services
- infectious diseases services
Quick detox:
a) Who is it suitable for?
b) What is first line treatment for opiate replacement?
a) Young user, Less time addicted, Often not injecting, Lower level of drug use
b) Buprenorphine
Cocaine use
a) Is there a substitute?
b) What might a ‘brief intervention’ involve?
c) Should also follow rules of harm reduction (prevent deaths and disease, refer where appropriate)
a) No
b) explanation of effects, explanation of risks, advice on controlled use, setting limits, cognitive based approaches
What drug is commonly used in opiate relapse prevention?
How does it work?
Naltrexone
Antagonist at opioid receptor
