Substance misuse Flashcards
define what is meant by harm reduction
Harm reduction attempts to reduce the adverse consequences of drug use among persons who continue to use drugs. It developed in response to the excesses of a “zero tolerance approach”. Harm reduction emphasizes practical rather than idealized goals. It has been expanded from illicit drugs to legal drugs and is grounded in the evolving public health and advocacy movements. Harm reduction has proved to be effective and it has gained increasing official acceptance; for example, it is now the basis of Canada’s Drug Strategy. However, the concept is still poorly defined, as virtually any drug policy or programme, even abstinence-oriented programmes, attempt to reduce drug-related harm. The principle feature of harm reduction is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time. Harm reduction is neutral about the long term goals of intervention while according a high priority to short-term realizable goals. Harm reduction should be neutral about legalization. The essence of the concept is to ameliorate adverse consequences of drug use while, at least in the short term, drug use continues
When should you suspect drug addiction ?
- When someone is arrested for theft to buy drugs
- Odd behaviour e.g. visual hallucinations, elation, mania
- Unexplained nasal discharge e.g. cocaine sniffing
- Marked veins, abscesses, hepatitis, HIV - due to repeated injections and possibly needle sharing
- Repeated requests for analgesia with opiates only being the acceptable form of analgesia
What is meant by harmful use of a substance ?
A pattern of psychoactive substance use that is causing actual damage to the mental or physical health of the user
What factors suggest dependence of a substance ?
3 or more of the following:
- Strong desire or sense of compulsion to take the substance (craving)
- Difficult in controlling substance use (onset, termination, level of use)
- A physiological withdrawal state when reducing or ceasing substance use
- Tolerance: increased doses are required to produce the original effect
- Progressive neglect of alternative pleasures or interests (choosing the substance over these)
- Persisting use despite clear evidence of harmful consequences
What signs/symptoms may indicate acute intoxification of a substance ?
Disturbances in level of consciousness, cognition, perception, affect or behaviour
What are the signs/ symptoms suggestive of opiate overdose ?
- Miosis - constricted pupils
- Bradyponea - RR <12
- Altered mental state - drowsiness or sleepiness ==> possibly leading to unconsciousness
- May see fresh needle marks, also evidence of old needle marks
- Symptoms dramatically respond to naloxone administration
What is the treatment of opiod overdose ?
Oxygen + Naloxone (this is the key part of it is reversing the effects)
What type of drugs are methadone and buprenorphine ?
- Methadone is an opiate prescribed by doctors as a substitute for heroin
- Buprenorphine is an opioid used to treat opioid addiction
Describe the detoxification management of someone with opiod addiction
Detoxification - options:
Self-detoxification (with support)
- Reducing prescribed opioids - using either methadone or buprenorphine (are the drugs used to reduce withdrawal symptoms note cant die from opiate withdrawal like in alcohol)
- Alpha 2 adrenergic agonists (2nd line to reducing prescribed opiates - Lofexidine)
Adjunct treatments - loperamide (reduce diarrhoea), hypnotic, NSAID
Aim is to get everyone to come completley off heroin but often cant and need to keep them on a maintenance dose of opiates
What are the symptoms of opiate withdrawal?
What is the maintenance treatment of someone with opiod addiction (replacement prescribing for heroin)?
- 1st line = methadone
- 2nd line = bupenorphine
Also consider counselling, CBT etc
