Drug Misuse 2 (harm reduction)

Question 1

Appreciate why harm reduction approach to drug misuse has been adopted

Answer 1

•Rationale 
- accept
    •a proportion of people will continue to inect drugs
- help
  •them to do so as safely as possible

Question 2

Describe the risks involved when injecting drugs and

be aware of the advice that pharmacist could give to drug misusers to minimise these risks

Answer 2

Risk of IV heroin

• physical dependence leading to crime
• overdose
• HIV infection
• Hepatitis infection
• Bacterial infection
• Damaged veins

Advice

• preparation of drugs for injection
• advice on injecting site
• advice in injecting technique

Question 3

Describe the support that can be provided to drug misusers via the harm reduction approach

Answer 3

How can we reduce harm associated with injecting?

• provide education on safe injecting
• provide a supply a sterile injecting equipment
• provide clean:sterile paraphernalia
• accept the return of used injecting equipment for safe disposal

Question 4

Be aware of the different agencies available to support drug misusers

Answer 4

Organisations involve in drug misuse:
- local authorities
- Manchester city council
- health and well-being board
• alcohol, drug and substance abuse
- NHS services
- community pharmacy needle exchange
- CGL - change Grow live, a voluntary sector organisation specialising jn substance misuse
&raquo_space; Manchester Integrated Drug and Alcohol Service (MIDAS)

Question 5

1. Preparation of drugs for injection

How to inject and prepare

Answer 5

Heroin availabe as free base and salt

- free base (C21H23O5N)
Convalently bonded molecule
Which is uncharged 
Likely to have low bp
Attraction between ion relatively week compared to salt 
- Salt higher mp and bp

So you would
Smoke freebase
Inject salt (likely to be more soluble in water)

How to convert freebase to salt:

• react with citric acid or ascorbic acid
• mix the freebase, acid with water and the heat in a cooker
• filter(usually not ideal and pharmaceutical would not use) and drawn with syringe

Locate vein:

• tourniquet
• insert needle into vein and draw up some blood (thats how you know you’ve hit a vein)
• inject drug
• withdraw needle

Question 6

1. Preparation of drug injection

Dos and donts

Answer 6

Do:

• wash your hands
• use sterile equipment
• prepare on clean disposable surface (eg newspap)
• use your own ‘cooker’ water and filter
• use the smallest amount of acid
• reduce the amount of drug after a period of abstinence (because tolerance can occur making u take more of the drug so reduce to prevent addiction)

Dont:

• use more than one drug
• use lemon juice (risk of fungal infections)or vinegar (ethanoic acid is too strong)
• crush tablets

Question 7

2. Advice on injecting sites

Answer 7

✅✅✅✅✅

• peripheral veins are ‘safer’ than deeper veins’
• it is better to have several sites and rotate them

❌❌❌❌❌
Avoid
- Femoral vein
- veins in the neck, penis or breast

Question 8

3. Advice on injecting practice

Answer 8

Do:

• use the smallest needle
• use a tourniquet to identify vein and release prior to injecting
• inject on the line of the vein (towards the heart)
• use a shallow angles
• inject slowly
• apply pressure to site

Do not:

• share equipment
• inject alone