Substance misuse

Question 1

What are some examples of substances?

Answer 1

Opioids
Opiates
Heroin
Cannabis
Cocaine
Extras i.e MDMA, spice, stimulants - amphetamines

Question 2

What are the 2 types of dependence and what do they mean?

Answer 2

Physical dependence - tolerance

Psychological dependence - unable to face life without the drug

Question 3

What are some side effects of methadone?

Answer 3

: confusion, arrhythmia, constipation, dizziness, drowsiness

Question 4

4 criteria for addiction?

Answer 4

1) Craving
2) Tolerance
3) Compulsive drug-seeking behaviour
4) Physiological withdrawal state if not given drug

Question 5

Some effects of dependent drug use?

Answer 5

Physical

1) Acute - abscess, cellulitis, DVT
2) Chronic - Blood-borne virus transmission

Social

1) Imprisonment
2) Social exclusion

Psychological

1) Fear of withdrawal
2) Guilt
3) Craving

Question 6

What is the treatment for:

1) Detoxification?
2) Maintenance?
3) Relapse prevention?

Answer 6

Detoxification - Lofexidine, buprenorphrine
Maintenance - Buprenorphrine/Methadone
Relapse prevention - Naltrexone

Other forms: cognitive intervention

Question 7

Benefits of maintenance therapy for opiate users?

Answer 7

1) Significantly reduces mortality
2) Reduces drug-related morbidity
3) Reduces risk taking behaviour and spread of blood-borne viruses
4) Can be done safely without introducing iatrogenic risk

Question 8

What tests can you offer a newly presenting drug user?

Answer 8

Health check
Screening for blood-borne viruses
Contraception, smear
Sexual health advice
Immunization status and Hep A/B
Signposting for additional help (counselling, benefits, housing)
Information on local drug services

Question 9

How do you do a quick assessment for newly presenting drug user?

Answer 9

Which drug?
Route of administration?
How long addicted for?
What is the patient's goal?
Does the patient need referral?
Needs specialised support i.e child protection issues

Question 10

3 things of basic harm reduction for doctors?

Answer 10

1) Action to prevent deaths
2) Action to prevent blood-borne virus transmission
3) Refer when needed

Question 11

Young user, not so addicted, often not injecting, lower level of drug user –> what treatment 1st line?

Answer 11

Buprenorphine

Question 12

3 principles for crack cocaine treatment?

Answer 12

Harm reduction
Brief intervention
Team working

Question 13

Newly presenting untreated drug user in hospital. What do you do?

Answer 13

Take full drug history
Confirm drug use by urine testing
Opiate users: titrate onto methadone if signs of withdrawal develop
Benzodiazepine addiction: observe and seek expert advice if withdrawal symptoms develop
Give analgesia i.e analgesic ladder, buprenophrine may need alternative analgesia (high affinity binding reduces efficacy of other opioids)