Week 2: Perinatal substance misuse Flashcards
What Is The Purpose of A Drug And Alcohol Assessment?
Find out why they started using, at what point and if they’ve had any periods of abstinence (their tolerance levels will be lower so shouldn’t go back to the same dose)
Confirm that the client is using drugs
Establish which drugs are used
Assess dosages take and methods of use
Assess the degree of dependence on the drug, if any
Assess their alcohol consumption
Assess degree of dependence on alcohol, If any
Establish drinking patterns
Assess clients level of motivation and reasons for seeking help at this time
Give information about reducing the harm of drug/alcohol use
To build a clear picture of the clients history and present situation
What are the signs and symptoms of drug use?
Nervousness and irritability Mood swings – High or Low Paranoia and delusional thinking Excitability & excessive talking Tiredness & Lethargy Sweaty / shaky Weight loss / Gaunt facial features Sores around mouth and nose Dilated or constricted pupils Poor personal hygiene Poor complexion Evidence of poor circulation in MCAT users (blue heaters)
What are the signs & symptoms of drug or alcohol misuse use on a home visit?
Smell – Cannabis and MCat very distinctiveGeneral untidiness
Drug paraphernalia – baggys (little plastic bags), scales, grinders, bongs and pipes, presence of tin foil, straws, rolled up notes or paper, wraps, mirrors
Large amounts of empty alcohol bottles and cans both inside the house and outside in recycling bin
Lack of food in the home
What is the harm reduction approach?
The reduction of drug/alcohol related harm is the process of gradually reducing psychological social, medical and legal problems to a safer overall level in the context of continued drug and alcohol use
Harm reduction is a way of reducing the impact of drug/and / or alcohol-related harm to individuals and the community
What are the intermediate goals of harm reduction?
Cessation/reduction of injecting
Reduction of high risk behaviour
Reduced crime
Increased stability of drug and alcohol use reduction in drug/alcohol use
Improvement in medical health
Increase in emotional and psychological wellbeing
Improvement of relationships
Ability to maintain or gain employment or education course
Overdose prevention
What are some harm reduction strategies?
Access to clean injecting equipment Access to services Substitute treatment - methadone, acamprosate and buprenorphine , naltrexone Overdose prevention advice Advice on how to inject safely Blood borne virus testing and vaccinatio
What are the treatment options?
Substitute prescribing – Methadone, Buprenorphine, Subutex, Naltrexone, Diazepam
Detox v Stabilisation
Inpatient v Community
Rehabilitation
What is methadone?
Methadone dosing during pregnancy should be titrated to a level that not only blocks withdrawal symptoms but also suppresses heroin use, keeping the dose as low as possible in an attempt to reduce neonatal abstinence syndrome
During pregnancy methadone dose increases may be required due to increased metabolism and increased blood volume
First line treatment for pregnancy opioid dependents is Methadone
How can you manage vomiting in pregnant women?
Discourage from ingesting methadone on an empty stomach
Encourage woman to sip dose slowly
Consider splitting the dose
Look for other causes of vomiting i.e UTI
Consider need for improving nutritional status
Assess for dehydration
If vomited within 10 minutes of ingestion consider giving half a repeat dose (if witnessed vomiting)
After 60 minutes consider repeat dose if withdrawal occurs
Effects of methadone are at there peak between 4-6 hours but should hold for 24-48 hours?
Is bupenorphine (replacement drug) safe to use in pregnancy?
Safety of buprenorphine has not been demonstrated in pregnancy
However if a woman is already on an Buprenorphine programme acceptable to continue during pregnancy and breastfeeding
Risks of returning to heroin use outweigh the risks of continuing to use Buprenorphine
Is naltrexone safe to use in pregnancy?
The safety and efficacy of Naltrexone in pregnancy is not established
Good practice follow up babies who are exposed to Naltrexone in the womb
How is detoxification from opioids/ methadone managed?
Associated with a high risk of relapse to heroin should not be encouraged
Discuss risks and benefits to foetus
Priority access to treatment
Reduce by maximum of 5 ml weekly
Split dosing may help to stabilise in-utero conditions by reducing the difference between the peaks and troughs of methadone in the blood
Extra points from lecture
Women shouldn’t stop drinking completely if they’re highly dependent as it can cause them to fit and cut off the oxygen supply to baby which could lead to brain damage.
Breastmilk is encouraged with women who use drugs as small amounts will pass on to baby which will calm them and act as detox
Methadone is longer lasting than crack cocaine (a stimulant)
Women often need a higher dose due to increased blood volume and metabolism
Illegal drugs, e.g. crack cocaine and heroine are stimulants and depressants so have worse effects and are shorter lasting therefore more addictive than prescribed anti-depressant drugs. Individual women can have different responses to both types of drugs, even with anti-depressants a woman could become very addictive or not very.
Motivational interviewing
