Substance Misuse

Question 1

What factors indicate addiction

Answer 1

Craving
Tolerance
Compulsive drug seeking behaviour
Physiological withdrawal site

Question 2

What are the physical effects of drug abuse

Answer 2

DVT
bacterial endocarditis
Abscesses
Overdose.
Poor pregnancy outcomes
Side effects of opiates

Question 3

What are the effects of heroine

Answer 3

Euphoria, intense relaxation, miosis, drowsiness

Question 4

What are the adverse effects of heroin

Answer 4

Dependence, nausea, itching, sweating, constipation, overdose

Question 5

What are the routes of heroin

Answer 5

IV, smoking/chasing, snorting, oral, subcutaneous, IM, rectal

Question 6

How often do people tend to need heroin

Answer 6

Every 8 hours

Question 7

Effects of cocaine

Answer 7

Confidence, well-being, euphoria, impulsivity, increased energy, alertness, impaired judgement, decreased need for sleep

Anxiety, arrhythmias, crash dysphoria, depression, panic, paranoia, psychosis, damaged nasal septum, CVA, respiratory problems (crack lung)

Question 8

Cocaine use routes

Answer 8

Oral, snorting, smoking, IV

Question 9

What are the modalities of treatment in drug abuse

Answer 9

• Harm reduction - especially for non opiate users
• Detoxification (lofexidine and buprenorphine)
• Maintenance: methadone (full agonist) and buprenorphine (tablet under the tongue, blocks the effects of heroin, partial agonist)
• Relapse prevention (naltrexone: makes the effects of heroin feel horrible) Naloxone injections (lasts 10 mins so need to be kept in hospital)
• Psychological interventions- PSI is good for crack
• Alternative therapies
• Referral for allied problems (Hep C, STDs, etc)

Question 10

Options for drug users with doctors

Answer 10

Health check
Screening for blood borne viruses and referrals for positive results (Hep C and HIV)
Contraception and smears
Sexual health advice
General immunization
Sign post to additional help
Information on local drugs services including needle exchange

Question 11

Questions to ask in an assessment

Answer 11

Which drug
Route of administration
How long addicted
Goal
Needs for referral? 
Do they need specialised support

Question 12

What is the quick detox

Answer 12

• Buprenorphine, buscopan (for stomach cramps) and benzodiazepines (for anxiety)
• Other symptomatic medication
• Support from other agencies

Question 13

Which drugs are used in stabilization and maintenance and how is it assessed

Answer 13

• Methadone or Buprenorphine
• Urine samples to check they are using the medication
• for methadone titrate from a low starting dose to a maintenance dose, until patient is comfortable they don’t need to use heroin for 24 hours (helps to avoid overdose) supervised during taking the medication by a pharmacist

Question 14

What medication is used in relapse prevention

Answer 14

Naltrexone

Question 15

What medication should you be wary of in relapse prevention

Answer 15

Avoid long term benzodiazepines