Drug misuse

Question 1

What is in the ICD-10 addiction definition?

Answer 1

Craving
Tolerance
Compulsive seeking behaviour - differentiate from dependance

Question 2

Physical effects of drug use (acute and chronic)

Answer 2

Acute
-	Injecting - DVT, abscess
-	OD and resp depression
-	Poor pregnancy outcomes
-	Opiate SE - constipation, etc. 
Chronic
-	Blood-borne viruses (Hep C 50% in IVDU)

Question 3

Social effects of drug use

Answer 3

Family break down
Crime
Poverty and homelessness

Question 4

Psychological effects of drug use

Answer 4

Fear of withdrawal
Craving
Guilt

Question 5

Heroin - route

Answer 5

Any

Question 6

Heroin - lasts

Answer 6

6-8 hours

Question 7

Heroin - effects

Answer 7

Escape from real world

Question 8

Heroin - adverse effects

Answer 8

Dependance

Physical - nausea, itching, sweating, constipation

OD

Question 9

Cocaine - route

Answer 9

oral
snorting
smoking
IV

Question 10

Cocaine - MOA

Answer 10

Blocks re-uptake of serotonin and dopamine neurotransmitters (more of it floating about)

Question 11

Cocaine - acute effects

Answer 11

Intense pleasure

Anxiety, panic

Adrenaline secretion - confidence, euphoria, energy, alertness, impaired judgement

Question 12

Cocaine - chronic effects

Answer 12

Paranoia, psychosis, damaged nasal septum, respiratory (crack lung)

Question 13

Aims of drug tx

Answer 13

Reduce harm to - user, family and society

Improve health

Stabilise lifestyle - reduce amount of drug use

Reduce crime - benefits for wider society

Question 14

What help can be offered

Answer 14

Health check

Screening for blood borne viruses

Contraception

Smear

Sexual health

Immunisations, especially Hep C

Signpost - benefits, counselling, housing, local drug programmes (e.g. needle exchange)

Question 15

Main principle of tx

Answer 15

Harm reduction (px of death and blood borne disease)

Question 16

Drugs used for detoxification

Answer 16

Lofexidine

Buprenorphine

Question 17

How does Lofexidine work?

Answer 17

Reduces withdrawal symptoms (not an opioid)

Question 18

How does buprenorphine work?

Answer 18

Reduces withdrawal symptoms (weak opioid), used for first two days

Question 19

What drug is used for maintenance tx?

Answer 19

Methadone

Question 20

How does methadone work?

Answer 20

Weak opioid

Do NOT prescribe to those that take lots of heroin

Question 21

Relapse prevention medication

Answer 21

Naltrexone

Naloxone

Question 22

How does naltrexone work?

Answer 22

Feel unwell if take heroin as well

- Regular urinalysis to ensure taking the drug

Question 23

How does naloxone work?

Answer 23

Opioid receptor antagonist medication that can eliminate all signs of opioid intoxication to reverse an opioid overdose. It works by rapidly binding to opioid receptors, preventing heroin from activating them.

Question 24

Psychological interventions

Answer 24

AA

Motivational enhancement therapy

’12 Step Programmes’

Family therapy

Question 25

Who else is involved in a drug users care?

Answer 25

Referral for allied problems - Hep C - STDs - etc.

Question 26

What is involved in a rapid assessment of a drug user?

Answer 26

What drug? Route? How long addicted? Patient’s goals? Referrals needed? Any other medical problems/ complications - Interagency involvement?

Question 27

Use of methadone for inpatients

Answer 27

Confirm dose on admission Do not give with benzodiazepines Be careful with methadone and analgesia (continue with normal pain ladder) Pain needs treating, as with anyone else Must have a prescription when discharged (akin to discharging a diabetic without their insulin)

Question 28

What is spice?

Answer 28

Legal high - but now illegal Potent cannabinoid - high concentration of THC (made, not grown) ‘Zombie state’ - no control over potency so dosing varies massively between doses Many accidental ODs Smoked in a spliff

Question 29

What national guidelines are there for treating drug users?

Answer 29

Drug Misuse and Dependance: Guideline on Clinical Management, 2007

Question 30

What does the GMC say about drug users?

Answer 30

Drug users have the same right to the NHS as all other patients All patients have a right “to high quality care, irrespective of their medical condition”