W20 Substance Misuse Flashcards
What are the Tiers of Treatment in the Substance Misuse System? (4)
Tier 1: Non-drug treatment specific services
Tier: 2: Open access services and harm reduction services
Tier 3: Structured Community-Based Services – Specialist and GP
Tier 4: Rehab
The Misuse of Drugs Act 1971
What 3 classes are illegal drugs categorised into?
Illegal drugs are divided into classes according to the harm they cause and the criminal penalties attached:
Class A= Ecstasy, LSD, heroin, cocaine, crack, magic mushrooms, crystal meth
Class B= Cannabis, amphetamines, ketamine, barbiturates, codeine
Class C= tranquilisers, some painkillers, GHB, khat
What are stimulants, depressants and hallucinogens?
Examples?
Stimulants
* Speed up the way the body works
- Amphetamine, MDMA, Cocaine, Crack
Depressants
* Slow down the way the body works
- Benzodiazepines, Opioids, Alcohol, Cannabis
Hallucinogens
* Changes perception of reality
- LSD, Magic Mushrooms, PCP, Ketamine
What is the ICD 10 Definition of harmful use?
The diagnosis is made when an individual has a pattern of substance use that is causing damage to their health. The damage may be physical (eg liver damage or hepatitis) or mental (eg episodes of depression due to heavy consumption). This condition is diagnosed only when the individual does not fulfil the criteria for dependence.
What is the ICD 10 Definition of Dependence syndrome?
Dependence syndrome:
A physical syndrome which occurs after repetitive use of a psychoactive substance, typically for months or years.
The diagnosis of dependence should only be made if three or more of the following have been experienced at some time during the previous year:
* A strong desire to take the substance.
* Difficulties in controlling the use of the substance.
* A withdrawal syndrome when substance use has ceased or been reduced.
* Evidence of tolerance such that higher does are required to achieve the same effect.
* Neglect of interests and an increased amount of time taken to obtain the substance or recover from its effects.
* Persistence with the substance use despite evidence of its harmful consequences.
What makes up the Edwards and Gross criteria?
- Narrowing of the behavioural repertoire
- Salience of drinking and drug use
- Subjective awareness of compulsion2
- Increased tolerance
- Repeated withdrawal symptoms
- Relief from or avoidance of withdrawal symptoms
- Post abstinence re-instatement
Prochaska and Diclemente
Stages of Change
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
Assessment of substance misuse?
What are the steps?
- Confirm the patient is taking drugs (History, examination and drug testing).
- Assess the degree of dependence.
- Identify physical and mental health problems.
- Identify social problems – including housing, employment, domestic violence and offending.
- Assess risk behaviour.
- Determine the patient’s expectations of treatment and desire to change.
- Determine the need for substitute medication.
- Obtain information about dependent children.
How are drugs users assessed? What to ask?
Need to ask about:
* Type of drug/s used
* Pattern of use (duration, quantity, frequency of use, last 1–3 days, and last month, and whether continuous or binge)
* When last used
* Other drugs used (current, concurrent, and previous, reasons and patterns of use of other drugs)
* Route/s of administration
* History of use (age commenced, periods of abstinence)
* Circumstances and consequences of use
* Previous treatment (past withdrawal history, attempts to cut down/ stop)
What are the medical complications of drug misuse?
Hazards of drug?
Hazards of injecting?
Hazards of the drug
* Overdose
* Psychosis
* Withdrawal seizures
Hazards of injecting:
Viral infections: HIV, hepatitis B and C
Septicaemia, Pneumonia, Pulmonary abscess, Infective endocarditis Allergic reactions Skin abscess, Osteomyelitis, Thrombophlebitis,
Gangrene
Drug Testing
Biological samples used?
2 TYPES OF ANALYSIS?
- Urine
- Oral fluid
- Hair
a) Screening test.
b) Confirmation / classification test.
USES OF DRUG TESTING? (3)
- Initial assessment and confirmation of drug use.
- Confirming treatment compliance.
- Monitoring illicit drug use.
What are some psychosocial interventions? (tier 2 services)
- Drug related advice and information.
- Adviceandsupportforsocialproblems.
- Harm reduction.
- Motivational interviewing.
- Relapseprevention.
- Complementary and alternative therapies (eg acupuncture).
Mainly used in cocaine and other stimulant misuse. Also in cannabis use.
Harm minimisation strategies
Education:
* Hazards of injecting drugs (especially sharing injecting equipment)
* Safer sex
* How to obtain sterile injecting equipment and
condoms
* How to clean injecting equipment if it must be re-used
* Dangers of overdose
* First Aid for drug misusers who become
unconscious
Direct Action:
* Hepatitis B immunisation for non-immune individuals
* Provision of sterile injecting equipment (preferably in
exchange for used injecting equipment)
* Provisions of condoms
* Offer of BBV testing
* Naloxone and BLS training
* Prescription of substitute oral drugs
What is Opiate analgesia addiction?
Those individuals who are dealing with chronic pain are at particular risk of developing an addiction to opiate painkillers. Most people who use prescription opiates will never develop any problems because of it. Those who are most at risk for developing dependence will be long term users. It is also believed that anyone who has had previous substance abuse problems will be at an increased risk of addiction to prescription opiates.
