Introduction to Drug Misuse - PowerPoint PPT Presentation

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Introduction to Drug Misuse

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Amphetamines - 'whizz' Opiates - 'gear' 'brown' Cocaine - 'crack' 'rock' 'stone' ... Stimulant - amphetamine, cocaine. Addictive potential. Mode of administration ... – PowerPoint PPT presentation

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Title: Introduction to Drug Misuse


1
Introduction to Drug Misuse
  • Les Goldman

2
Objectives
  • Gain basic knowledge of
  • Common current patterns of drug misuse
  • Local referral pathways
  • Available treatments

3
Commonly misused drugs
  • Cannabis - draw weed
  • Ecstasy, LSD
  • Solvents
  • Amphetamines - whizz
  • Opiates - gear brown
  • Cocaine - crack rock stone
  • Benzodiazepines - blues

4
Common patterns of drug misuse
  • Primary heroin IV or inhaled plus
  • Methadone, DHC etc when supplies low
  • Benzodiazepines for depression
  • Cocaine occasionally as treat
  • Cannabis daily
  • Primary cocaine use - intense binges plus
  • Heroin and/or benzos afterwards
  • Cannabis

5
Harmful effects result from
  • Properties of drug
  • Hallucinogen - ecstasy, LSD
  • Depressant - opiates, benzodiazepines
  • Stimulant - amphetamine, cocaine
  • Addictive potential
  • Mode of administration
  • Oral - overdose risk
  • Smoked / inhaled - heat, tobacco, ash, toxic
    fumes
  • Injected - overdose and infection risk, arterial
    injury, DVT
  • Use in combination
  • With other drugs
  • With alcohol

6
Primary Care interventions - assessment 1
  • 5 areas
  • Drug use (which drugs, quantity used, duration of
    use, mode of administration, experience of
    withdrawal and overdose, previous treatment)
  • Physical health
  • Psychological health
  • Social circumstances (friends, family support,
    housing, work)
  • Involvement with criminal justice system

7
Primary Care interventions -assessment 2
  • Objective confirmation
  • History
  • Examination
  • Investigation

8
Primary Care interventions - motivation
  • Cycle of change - something to offer at each
    stage
  • Precontemplation
  • Contemplation
  • Action
  • Maintenance
  • Relapse

9
Primary Care interventions - harm reduction
  • Accurate information about drug effects and risks
  • Verbal
  • Written
  • Encourage safer pattern of use
  • Care with combinations of drugs / alcohol
  • Smoke rather than inject
  • Safer smoking / injecting techniques
  • Manage physical health problems
  • Preventive health care
  • Overdose prevention (dont inject alone, learn
    basic CPR)
  • Vaccination (hep A, hep B, tetanus)

10
Appropriate referral 1
  • Bridge Project (non-statutory)
  • Counselling, harm reduction, needle exchange
  • Activities (music, IT, gym, complementary
    therapies)
  • Treatment
  • Womens Service
  • Young Peoples Service
  • Stimulant Service

11
Appropriate referral 2
  • PCT level primary care based services
  • NBPCT Drug Service
  • Ripple Project
  • City SMS
  • Personnel - GPwSI, CPN, physical health nurse,
    drugs worker, vocational advice, social support,
    carer support, community development
  • Principally opiate dependence services
  • Main exclusions
  • Complex poly - substance misuse
  • Serious mental health problems
  • Young people

12
Appropriate referral 3
  • Specialist Services
  • CDAT (Horton Park Centre)
  • One Stop Maternity Service
  • Young Peoples Service
  • Day Care
  • Detoxification programmes
  • Other services
  • Carers
  • Self help (Narcotics Anonymous)

13
Criminal Justice and Drugs
  • Drug Intervention Programme (DIP)
  • Restriction on Bail (ROB)
  • Drug Treatment Testing Order (DTTO)
  • Support workers
  • Structured activities

14
Principles of treatment 1 choice of intervention
  • Substitute prescribing
  • Appropriate for e.g. opiate and benzodiazepine
    misuse
  • Harm reduction
  • Physical
  • Psychological
  • Social
  • Maintenance / detoxification
  • Symptomatic relief
  • Appropriate for e.g. cocaine misuse
  • Relapse prevention
  • Medical - naltrexone
  • Non medical - supportive counselling

15
Principles of treatment 2 choice of
opiate substitute
  • Methadone
  • Long acting
  • Cant inject mixture
  • Sedating
  • Withdrawal sometimes difficult
  • Buprenorphine (Subutex)
  • Long acting
  • Blocking effect (safer but risk of precipitate
    withdrawal on starting treatment)
  • Less sedating
  • Easier withdrawal
  • Dihydrocodeine
  • Easily diverted
  • Easier withdrawal, useful for quick detox
  • Less potent

16
More information
  • Drug Misuse and Dependence - Guidelines on
    Clinical Management DoH 1999
  • www.smmgp.co.uk
  • Guidelines and info
  • www.drugscope.org.uk
  • Easy to use source of information
  • www.nta.nhs.uk
  • DoH agency commissioning drug misuse services
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