W15 52 drug and law: drug abuse Flashcards
What drugs can dentists prescribe?
Medication that has use in dentistry and meets the dental needs of the patient.
What is the medicines act 1968?
Law enshrines the manufacture, distribution and importation of all medicines for human and animal use ensuring safety and efficacy.
What are the 3 classes of medicinal products?
GSL - general sales list - sold or supplied other than under the direction of the pharmacist
P - pharmacy medicines - medicinal products sold over the counter from a pharmacy with a pharmacist present at time of sale
POM - prescription-only medicines - can only be supplied from pharmacies in accordance with a prescription from an approved practioner.
What is the misuse of drugs act 1971?
Controls the unlawful production, supply, possession and exportation of specific medicines considered to be dangerous or harmful (controlled drugs).
Give examples of the classes of drugs?
CLASS A - cocaine, heroin, LSD, ecstasy, pethidine
CLASS B - oral amphetamines, ketamine, codeine
CLASS C - bentos, anabolic steroids, GHB
What is the misuse of drugs regulations 2017?
Misuse of drug regulations provide a legal framework for legitimate use of controlled drugs (CDs), allow possession, supply, prescription, storage and administration as practicing professionals.
What are the prescription writing requirements for controlled drugs?
(Only for DENTAL pain)
- name and address of patient
- dose to be taken
- form (eg tablets) and strength
- frequency (or ‘as directed’)
- total quantity in words and figures
- the words ‘for dental treatment only’
- signature of prescriber and date
Dentists need to add their name, address and qualifications to the prescription form to comply with the misuse of drugs regulations.
What drugs are included in the dental practitioners formulary of controlled drugs? - NHS
Diazepam
Dihydrocodeine
Midazolam
Temazepam
What additional info is needed to prescribe privately?
A six-digit prescriber identification number which must be included on the pink private prescription forms (FP10PCD)
What are drugs of abuse?
The illlegal, non-medical use of a limited number of substances, most of them drugs, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful threatening or at minimum, culture alien.
What are the major drugs of abuse, legal and illegal?
Legal - ethanol, tobacco
Illegal - ecstasy, amphetamines, opium, heroin, cocaine
What is psychological, physical, and habituation dependence?
Psychological - necessity to prevent the unpleasant psychological reaction on stopping a drug
Physical - abnormalities of behaviour and physiological symptoms on withdrawal
Habituation - powerful ‘mindful’ stimulus to need to take a drug
How can you detect drug abuses?
A routine check of vital signs may also alert to the presence of substance intoxication or withdrawal at presentation
Eg needle track marks, candle to dissolve heroin injecting soot to tattoo veins
What are the generic issues with drug abuse relevant to dental practice?
Dealing with difficult patients
Demands for substances (for misuse)
Adverse oral effects of drugs of abuse (D of A)
Special need for dental care (ADA II/III)
Medical issues
What medical issues are there with drug abusers?
Abscesses at injection sites
Viral hepatitis/HIV
Endocarditis
Anaesthetic complications
Problems with dental sedation
Drug interactions
What special investigations might you take for patients admitting to substance misuse?
Cardiovascular/respiratory examination +/- investigations
Renal function, coagulation screen, platelet count, liver function tests
Hep B/C and HIV screen
What are the dental problems from alcohol?
Dental caries
Traumatised teeth
Periodontal disease
Recurrent oral ulceration
Dental cancer
Sialadenitis
What are the issues with marijuana?
Smokes at a much higher temp than tobacco so bigger damage to the aero digestive track due to high burning temp
Gingival hyperplasia
Leukoplakia
Oral cancer (tongue)
Craving for carbohydrates (increases risk of caries)
What drug abuse sedatives are there?
Opioids - eg morphine, heroin
Heroin - very quickly cross BBB to give a high and quick euphoria
Methadone - synthetic opioids
What are the effects of morphines?
Morphine is a mu opioid receptor agonist
Desired effects of opioid mu receptor stimulation are analgesia and euphoria
These effects are mediated mainly by dopaminergic pathways
What dental problems can opioids (heroin) cause?
Poor oral cleanliness
Xerostomia (opiates)
High sugar content (methadone solution)
Demand excess post-op analgesia
Increased bleeding (decreased platelet count)
What are the dental problems with cocaine?
Related to nasal inhalation, smoking and direct smearing on oral mucosa
Causes vasoconstriction, thus causing necrosis
Periodontitis
Ulceration
Gingival necrosis
Nasal septal necrosis
What is the effect of cocaine?
Local anaesthesia
Inhibition of catecholamines reuptake
Central stimulant effect
What are the effects of ecstasy and amphetamines?
Sympathomimetic
Orally
Euphoria, insomnia, over-activity
Users often become dehydrated
Interactions between TCAs and MAOIs
What are the oral effects of ecstasy?
Toothwear - bruxism
Jaw muscle tenderness
Xerostomia
Mucosal ulceration
Periodontitis
‘Meth mouth’
What is Khat and what are the oral effects?
Amphetamine like stimulant
Increases CNS and sympathomimetic effects
Oral effects: gingival recession, TMJ dysfunction, periodontal inflammation, oral leukoplakia/oral SCC
What is the issue with drug abusers and local anaesthetics/analgesics?
Many drug abusers with show tolerance to LA/conscious sedation/opiates
So they might require increased quantities to achieve pain-free treatment or other modalities (Co-analgesia)
What is tolerance?
Tolerance is the reduction in the effect of a drug due to prior exposure
Tolerance is proportional to dose/frequency of exposure
