Substance Abuse - Recreational Drug Abuse Flashcards
Number of people taking illicit drugs?Most common age group?
- 1 in 12 (1 in 3 for 16-24 yrs)
Most common illicit drug to be taken?
- Cannabis most common
Risk factors for illicit drug use?
o Young age, male gender o Low socioeconomic class o Psychiatric disorders o Impulsive personality o Genetic
Origin, names, route and mechanism of illicit drug - cannabis?
- Produced from dried leaves, flowers and seeds of Cannabis sativa
- Called grass, marijuana, hash, dope, skunk
- Route – smoked, eaten, drunk
- Mechanism – Acts on specific cannabinoid receptor in CNS
Origin, names, route and mechanism of illicit drug - volatile substances?
- Simple hydrocarbons such as acetone, toluene, butane have intoxicant properties
- Found in glue, solvents, lighter fuel, paint stripper, aerosols, paints, petrol, nail varnish
- Route – inhaled, sniffed
- Mechanism – rapidly absorbed, cause non-specific increased permeability of nerve cell membranes
Origin, names, route and mechanism of illicit drug - cocaine?
- White powder produced from leaves of coca shrub
- Called – C, Charlie, Coke, Crack cocaine (pure), Snow
- Route – inhaled (snorted), smoked, injected
- Mechanism – Sniffed bypasses first-pass metabolism, local anaesthetic at mucous membranes, blocks neurotransmitter reuptake for dopamine, serotonin and noradrenaline
Name the 4 stimulant drugs?
Cocaine, amphetamines, MDMA, Mephedrone
Origin, names, route and mechanism of illicit drug - amphetamines?
- Sold as tablets or white powder – used in narcolepsy and ADHD
- Types - Crystal meth, speed, Ritalin (methylphenidate)
- Called – Whizz, speed, billy, uppers, dexxies
- Route – swallowed, inhaled or dissolved and injected
- Mechanism – Similarity to dopamine and noradrenaline so is CNS stimulant
Origin, names, route and mechanism of illicit drug - MDMA?
- High profile links to dance music culture in the late 80s and early 90s
- Called – E, Eccies, MD, Mandy
- Route – Oral tablets
- Mechanism – Serotonin release and blocks reuptake
Origin, names, route and mechanism of illicit drug - mephedrone?
- Closely related to speed and ecstasy
- Called – meow meow, M-CAT, White magic, MC
- Route – oral, nasal, inject
- Mechanism – Releases dopamine and blocks reuptake
Name the 3 hallucinogen illicit drugs?
LSD, Magic Mushrooms, Ketamine
Origin, names, route and mechanism of illicit drug - LSD?
- Occurs naturally in Morning Glory plant
- Called - Acid
- Route – impregnated on paper, tablets, powder
- Mechanism – Serotonin agonist and acts on serotonergic and dopaminergic systems
Origin, names, route and mechanism of illicit drug - Magic mushroom?
- About 12 varieties with Liberty cap most common in UK
- Called - mushies
- Route – eaten raw, cooked, dried, drank
- Mechanism – Partial serotonin agonist
- Possession and consumption is not illegal unless prepared for illicit consumption
Origin, names, route and mechanism of illicit drug - ketamine?
- Structurally like phencyclidine used as anaesthetic in vets
- Called – Special K
- Route – Sniffed powder
- Mechanism - NMDA antagonist - blocks glutamate
Name the opiate illicit drugs?
Heroin - codeine, morphine, methadone, pethidine, buprenorphine
Origin, names, route and mechanism of illicit drug - heroin?
- Derived from opium poppy – opiates, opioids are synthetic compounds- Street heroin usually 25-50% pure
- Called – Brown, Gear, Skag, Smack
- Route – brown powder in wraps, smoking (chasing), orally, snorted, IV and IM
- Mechanism – Opioid agonist, binds to endorphin receptors
Name the 2 illicit depressant drugs?
Benzodiazepines, GHB
Origin, names, route and mechanism of illicit drug - benzodiazepines?
- Therapeutic uses anxiolytics, hypnotics, anticonvulsants and muscle relaxants
- Short-acting (temazepam, oxazepam), medium-acting (lorazepam, alprazopam), long-acting (diazepam, nitrazepam, chlordiazepoxide)
- Called – Vallies, downers
- Route – oral, can be injected
- Mechanism – GABA agonist
Origin, names, route and mechanism of illicit drug - GHB?
- Synthetic compound seen in dance settings
- Called – GBH, grievous bodily harm
- Route – liquid form
- Mechanism – GABA agonist
Which illicit drugs are non-addictive?
o LSD, mushrooms, MDMA
Describe the experimental pattern of illicit drug use?
o Explore effects
o Common and driven by availability and peer group
o Common for ‘softer’ drugs
Describe the situational pattern of illicit drug use?
o Limited to certain situations (e.g. parties, raves)
o Mainly stimulants or hallucinogenic
Describe the recreational pattern of illicit drug use?
o Regular but non-dependent use
o May be limited by period of life or may progress to dependent use
Describe the polydrug pattern of illicit drug use?
o Non-dependent use of variety of drugs
o Risks can be addictive or multiplicative
Describe the dependent pattern of illicit drug use?
o Use of drug for which dependence syndrome developed
o Continued use may be motivated by desire to avoid withdrawals
Effects of cannabis use?
- Effects act within minutes when smoked, reach a peak of 30 minutes and lasts 2-5 hours
- Mild euphoria, sense of enhance well-being, relaxation, increased appetite, talkative
Adverse effects of cannabis use?
- Mild paranoia, panic attacks, cravings, anxiety/depression, insomnia, psychosis, precipitates schizophrenia
Effects of volatile substance use?
• Euphoriant effects, disinhibition, slurred speech and blurred vision
Adverse Effects of volatile substances?
- Local irritation, headache, cardiac arrhythmias, unconsciousness, sudden death
- Liver and kidney damage, memory impairment
Effects of cocaine?
- Actions begin within a few minutes
* Increased energy, confidence, euphoria and no desire for sleep, reduces hunger
Adverse effects of cocaine?
- Arrhythmias (MI), dry mouth, dilated pupils, tachycardia, anxiety, hypertension, impulsivity, impaired judgement
- Nasal septum damage, panic disorders, delusions, psychosis
Effects of amphetamines?
- Similar effects to cocaine but slower metabolism gives longer duration of action
- Active, alert, confident, chatty, no need for sleep, improved focus, full of energy, reduced appetite
Adverse effects of amphetamines?
- Tachycardia, tachypnoea, arrhythmias, hyperthermia, irritability, dilated pupils, quasi-psychotic state with hallucinations
- Panic attacks, depression, psychosis, dependency, chronic sleep deprivation
Come down effects of amphetamine use?
- Lethargy, anergic, anxiety, irritability, restless, unable to sleep
Effects of MDMA?
- Hallucinogenic and stimulant properties
- Effects start 30 mins after ingestion and tend to last 3-4 hours followed by gradual comedown
- Energy buzz, alert, alive, feelings of love for people around them
Adverse effects of MDMA?
- Dilated pupils, dehydration, tightening of jaw muscles, hyperthermia, tachycardia, increased sweating, nausea, vomiting, reduced potency despite increased sexual libido
- Anxiety, panic attacks, psychosis, paranoia
Come down effects of MDMA?
• Come down (24-48 hours)
- Lethargy, anergia, anxiety, irritability, restless, unable to sleep
Effects of mephedrone?
• Feel alert, confident, talkative, euphoric, increased affection, reduced appetite
Adverse effects of mephedrone?
- Nausea, anxiety, vomiting, hallucinations, palpitations, seizures, reduced circulation, epistaxis, addiction, paranoia
Effects of LSD use?
- Effects act within 30 mins and last for 6 hours
* Initial euphoria, hallucinations, sensory distortions and altered perceptions
Adverse effects of LSD?
- Nausea, anxiety, vomiting, hallucinations, palpitations, seizures, reduced circulation, epistaxis, addiction, paranoia
Effects of Magic mushrooms?
- Euphoria, lethargy, relaxed, perceptual and sensory changes, hallucinations
- Tolerance develops quickly
Adverse effects of magic mushrooms?
- D&V, dizziness, poisoning, depression, anxiety, panic attacks, bad trips, flashbacks
Effects of ketamine?
• Relaxation, altered bodily sensations, floating feelings, dissociation, altered perception, hallucinations
Adverse effects of ketamine?
- Nausea, ataxia, anaesthetic, amnesia, panic attacks
Effects of opiates?
• Warm feeling, euphoria, relaxed, analgesic, constricted (pin-point) pupils, untethering from worries or concerns
When does dependency develop in opiates?
• Opiate dependency develops in weeks and associated with withdrawal symptoms
Adverse effects of opiates?
- Constipation, nausea and vomiting, respiratory depression, loss of consciousness, injection site infections
Effects of benzodiazepines?
• Relaxed, calm, sedated, euphoric
What can develop in benzodiazepine use?
• Tolerance develops rapidly, and dependence develops over 4-6 weeks
Adverse effects of benzodiazepines?
- Respiratory depression, falls, hangover, memory loss, sedation, infection when injecting
- Impaired concentration, memory and mood
Effects of GHB?
- Euphoria, reduces inhibitions, drowsiness, intoxication
* Effects start 15 minutes after ingestion
Adverse effects of GHB?
- Nausea, drowsiness, dizziness, agitation, visual disturbances, respiratory depression, unconsciousness, coma and death (mixed with alcohol)
What are the signs of dependence in illicit drug use?
- Tolerance
- Withdrawal symptoms
- Using more or for longer than intended
- Unsuccessful attempts to reduce
- Large time spent seeking, using and recovering from use
- Drug use taking priority
- Persistent use despite harm
What is the criteria for dependent drug use?
o >3 dependent signs in last 12 months
Withdrawal symptoms in cannabis? Management and advice given in cannabis use?
- Withdrawal Symptoms- Irritability, mood changes, nausea, loss of appetite, difficulty sleeping, shaking and sweating
- Illegal drug – reduce use and abstinence
- Don’t drive or operate heavy machinery
Management and advice given in volatile substances use?
- Education of users and ‘at risk’ groups
* Most use will be experimental
Withdrawal symptoms in cocaine use?Management and advice given in cocaine use?
• Withdrawal symptoms
- Low mood, unwell, insomnia, psychological dependence
• Harm reduction advice (clean needle)
• CBT and treat co-morbid psychiatric illness
Withdrawal symptoms in amphetamine use?Management and advice given in amphetamine use?
• Withdrawal symptoms
- Lethargy, drowsiness, poor concentration
• Harm reduction advice
Withdrawal symptoms in MDMA use?Management and advice given in MDMA use?
• Withdrawal symptoms - Lethargy, depression, memory problems • Harm reduction advice • Maintain hydration and avoid hypothermia • Take breaks from dancing
Management and advice given in mephedrone use?
• Withdrawal symptoms
- Lethargy, drowsiness, poor concentration
• Harm reduction advice
Management and advice given in hallucinogens (LSD, mushrooms, ketamine) use?
- Harm reduction
- Maintain safe environment and avoid behavioural toxicity
- Acute psychosis managed with BDZ with expectant resolution
Withdrawal symptoms in opiates?
COWS scale- Tachycardia, sweating, restlessness, dilated pupils, bone aches, runny nose, diarrhoea, tremor, anxiety and insomnia, gooseflesh skin
Harm reduction advice given in opiate use?
- Don’t use alone or in combination with other drugs
- Avoid IV
- Needle exchange programmes
Safe injection advice given in opiates use?
- Use new sterile needles each time, sterile water, never share needles, syringes, spoon
- Rotate injection sites, avoid neck, breast, groin, infected areas
- Inject with blood flow
Symptomatic relief of opiate dependence?
a. Lofexidine (alpha-adrenergic agonist)
b. Loperamide (Tx diarrhoea)
c. Metoclopramide (Tx nausea, vomiting)
d. Ibuprofen
Substitute prescribing in opiate dependence?
Methadone – daily dose for observed administration
Long-acting synthetic opiate – half-life 24 hours so daily dose
Near saturation of opiate receptors so minimises reward of further consumption
Coloured liquid, drank, sugar-free option availableiv
Used in opiate withdrawal and maintenance
Alternative to methadone for substitute prescribing in opiate dependence?
Buprenorphine – once daily sublingual
Partial opiate agonist
Produces less euphoria than methadone
Treatment of drug dependence
Advice for maintenance prescribing in opiate dependence?
- Prevent under-dosing and overdosing
- Methadone and buprenorphine review monthly/supervised
- Aim to titrate up to maintenance dose then, look to dose reduce each fortnight for 4-6 months if possible
Drugs used to prevent relapse in opiate dependence?Drug used in opioid toxicity?
• Opiate relapse prevention- Naltrexone
Aid abstinence in formerly depedent patients
• Overdose- Naloxone IV
Withdrawal symptoms in benzodiazepines dependence?
• Withdrawal symptoms
- Poor concentration, nausea, vomiting, tremors, headaches, anxiety, panic, depression, seizures
Substitute prescribing in benzodiazepines dependence?
Diazepam – taper off 1/8th dose per fortnight
General advice in benzodiazepines dependence?
- Do not operate heavy machinery
- Needle advice and safe injecting
Drug used to treat overdose in benzodiazepines dependence?
- Flumazenil
Withdrawal symptoms in GHB dependence?
- Insomnia, anxiety, tremor, delirium
General management given to illicit drug users?
o Tailor to specific needs (residential, outpatient care or groups) • Counselling • Motivational therapy • Cognitive therapy • Family therapy • Narcotics Anonymous
What advice should be given to IV drug users about risk?
o Educate about needle exchange, HIV, Hep C risk
• Safe injecting advice:
- Use new sterile needles each time, sterile water, never share needles, syringes, spoon
- Rotate injection sites, avoid neck, breast, groin, infected areas
- Inject with blood flow
Dependence on cannabis, amphetamines, MDMA, LSD, hallucinogens provides what legal issues?
- Loss of licence until 6-months (group 1) or 1-year (group 2) period of abstinence
- Medical assessment and urine screen may be required
Dependence on heroin, morphine, cocaine, methadone provides what legal issues?
- Loss of licence until 1-year (group 1) or 3-year (group 2) period of abstinence
- Independent medical assessment and urine screening needed
- May need consultant recommendation
Symptoms of overdose of opiates?
• Respiratory depression – death
Symptoms of overdose of cocaine?
• Tremor, confusion, seizures, arrhythmias, MI (common), cardiomyopathy
Symptoms of overdose of MDMA/Amphetamines?
• Arrhythmias, hypertension, stroke, circulatory collapse, seizures, coma
Symptoms of overdose of LSD?
• Rare – nausea and vomiting, autonomic overactivity, hyperthermia, coma
Symptoms of overdose of cannabis?
• Confusion, psychosis
Symptoms of overdose of BDZs?
• Over-sedations, coma, death, respiratory arrest
