Liam (Drug Misuse and Abuse) Flashcards
Year 1 recap
Human Medicine Regulations and POMs
- Requirements for prescriptions and supply of medicines and POMs
Misuse of Drugs Act and Regulations
- Different schedules for CDs
- Rules about supply of CDs
- Prescription requirements for CDs
- Records for the supply and recite of CDs
- Safe custody of CDs
History of drugs of abuse and legislation
- Before 20th century drugs like heroin and cocaine were freely available for many things such as toothpaste and coughs
- There was international clampdown on drug misuse and abuse in the 1950s
- Legislation was introduced in 1960s leading to the Misuse of Drugs act 1971
- Total prohibition on the possession, supply, manufacture, import or export of CDs except:
- As allowed by the Misuse of Dugs Regulations
- Under a license from the Secretary of State for the Home Office - Established the Advisory Council on the Misuse of Drugs (ACMD)
- Advises ministers on how different drugs should be restricted and how to treat the problem of drug abuse and misuse in society
- Total prohibition on the possession, supply, manufacture, import or export of CDs except:
Misuse of Drugs Act 1971
- Classifies CDs in classes (A, B, and C) based on penalties duo possession, supply, or manufacture
- Classifies CDs in schedules (1-5) based on rules for legal supply and possession
Prevalence of drug misuse and abuse
- High
- 8% of people aged 16-59 had taken an illegal drug in the past year and 4% in the past month
- 18% of people aged 16-24 had taken an illegal drug in the past year and 9% in the past month
- 35% of adults have taken an illegal drug at some point in their lives
- 3% were defined as frequent users- more than once a month on average in the past year
- Use of a class drug was around 10x higher in those who had visited a nightclub at least 4 times in the past month
- 5% of 15 year olds had used cannabis in the past month
- Men are more likely to have used illicit drugs than women
- Death rate has increased each year from 2014
Risk factors
Environment
- Chaotic home life
- Abuse
- Parents use of illicit drugs and their attitudes to drugs
- Poor influences
- Peer influence
- Community attitude
- Poor school achievement
Biology/genes
- Genetic predisposition to become addicted
- Gender (men more likely to abuse drugs than women)
- Mental disorders
Cost
Availability
Effect of drug itself
Route of administration
Homelessness
Poor working conditions
Unemployment
Legal highs
New Psychoactive Substances (NPS’s)
- Mephedrone in the 2000s
- Some local enforcement followed by new national action
- Issues:
- Substances are not controlled under MDA as they are not classified as a drug
- Two ways to address the issue
- Psychoactive Substances Act 2016
- Temporary Class Drug Orders- classes the chemical as a drug for the purpose of the misuse of drug act even though it hasn’t gone through any regulation processes of drugs
Difference between drug misuse and drug abuse
Misuse- implies the use of the drug in an inappropriate but maybe well intentioned way. e.g. laxatives used too much, nasal decongestants overuse, painkillers used for too long
Abuse- implies deliberate use of the drug outside of its license to achieve an inappropriate aim.
The main difference is intent.
Terms are used interchangeable but are not the same.
Substance abuse and misuse is a broader term and includes non-drug substances
Addiction, dependance, and tolerance
Addiction- defined as not having control over doing, taking, or using something to the point where it could be harmful to you. e.g. gambling, sex, gaming, drugs
Dependance- occurs when the body relies on a drug physically, or psychologically
- Physical- body adapts to the presence of a drug and in its absence there are withdrawal symptoms
- Psychological- based on our need for the drug but no physical dependance on it. e.g. sleep aids which contain anti-histamine and cause drowsiness but do not cause changes to the body to create physical dependance. People believe they need the drug and create a psychosomatic reaction to not having them
- Tolerance- a persons diminished response to a drug which occurs when the drug is used repeatedly and the body adapts to the continues presence of the drug e.g. opiates
What can be abused?
Substances
- Alcohol
- Tobacco
- Nicotine
- Solvents
- Nitrous oxide
OTC medicines
- Codeine
- Pain killers
- Sleeping aids
- Laxatives
- Antidiarrhoeals
- Proplus (caffeine tablets)
- Vicks Vaporub
Rx medicines
- Pain killers
- Opiates
- Methadone
- Anxiolytics
- Antidepressants
- Sleeping tablets
- Steroids
Illicit drugs
- Heroin
- Other opiates
- Cocaine
- Crystal meth
- amphetamines
- Rohypnol (sleeping pill)
- MDMA
- Marijuana
- GHB (general anaesthetic)
- LSD (acts on CNS)
- Anabolic steroids
Aims of treatment of substance misuse
- Reducing harm- to individual and community
- Discontinuation of the substance use- detoxify patient and help stop using substance
- Address social issues- substance misusers often have a number of social issues such as family issues, housing, homelessness, unemployment, theft
- Reintegration into societal role- help them in their role as a parent, partner, employee, etc
Treatment of substance misuse
Detoxification
- Substitution with sufficient appropriate drug to enable switch from illicit use
- Followed by gradual reduction of drug until not physically dependant
Stabilisation
- Low and steady level use of the drug until they are ready to stop
Maintenance
- Longer term management using drug substitute
- Rehabilitation and re-integration
- In all cases a vital part of treatment
Services involved in drug misuse treatment
- Childcare
- Vocational
- Mental health
- Medical
- Educational
- HIV/AIDS
- Legal
- Financial
- Housing/transportation
- Family
Challenges of drug misuse therapy
- Patients often remain in a community of peers who are drug using
- Relapse is common- withdraw over 3-6 months
- Try to remove patient from temptation in environment
- Side effects- constipation, sweating
- Only partly successful
- Illicit use/sales of methadone- people get it on prescription as substitute for drugs then sell it
- Concomitant use of illicit substances is common- e.g. use methadone as a baseline and still go for a hit from other drugs. Why it is important for other services to get involved to get a holistic approach to the situation
Services provided in community pharmacies
- Dispeinsing
- Instalment dispensing- for drugs being used as a substitute for illici drugs
- Supervised consumption
- Needle exchange
Why we provide these services
- Reduces street diversion- reduces amount of drugs going onto the street
- Aids compliance- helps patient to regularly take their medication
0 Prevent harm to others- patients are less likely to inject whilst using services - Improves control and safety
- Daily contact with a healthcare professional
- Opportunity for fried advice and signposting
- Early intervention if things go wrong
