Opiates and cannabis

Question 1

What are opiates and how cna they be taken

Answer 1

derives from poppy-
heroin (ak brown, smack, hrose, skag)-morphine
Pethidine- codeine

gives immediate euphoria, diminished pain, feelings of detachement

start with smoking (chase the dragon and progress to Sniffin (snorting), oral, IV mainlining), IM/SC (skin popping)

Question 2

Sx of opiate use (including complications)

Answer 2

Sx of intoxication-
euphoroa and warmth, sedation
Overdose -pinpoint pupils and low RR (naloxone)
Low dose SE - constipation

Withdrawal -6h after last inject, peak 36h, last 5-7d)
craving, nausea, insomnia, agination
most comment - flue like, runs (DV, lacrimation), Goose flesh, mydriasis
rarely life threatening

Complication-
local to site -absesses, cellulitis, DVT, emboli
Systemic -septicieamia, infective endocariditis, Blood blord Infection, overdose
Pseudoaneurysms

Question 3

Ix of opiate use

Answer 3

Physical exam -establish state
Urine drug screen- syays 2 days in
UE - malnutrition
FBC- anemia/infection
LFT - 
Blood born infections

Question 4

Mx of Opiate abuse

Answer 4

General- appoint key worker and develop care plan - agreed tx and recovery goals with specific plans
Harm reduction- complete abstience unlikely so be safe - needle exchange for IVDUs, vaccinations
Narcotic anonynous

discuss- if they want opioid substittion therapy (withdraw or maintain regimen)
1st maintain- stabilise life, then withdraw

maintenance- 1st line methadone/buprenophrine -keep low if still using, but high dise or stopped fully
offer naloxone for home emergency

OR

Detox- commited and educated to withdraw
Must be 12w of stable OST, outpatient
Lose tolerance- so if start again, lower dose
1st line methadone/buprenophrine - with emergency naloxone for home
2nd line - lofexidine for Sx

Follow up–
at least 6m of signs of withdrawal, drug screencs, ECG (QTc) if on methadone, CBT

Question 5

What is cannabis

Answer 5

Active ingredient -THC
grass/weed-dried leaves
hash- made from resin
Skunk/sinsemilla - strong varieties -most commonly used

Usualy smoked, but edibles and IV exist

Question 6

Sx of cannabis use

Answer 6

Depends largely on expecation and original mood state-
spectrum of -euphoria, relaxation to paranoia, anxiety
Percetual time disortion, hunger
NV (greening)

Question 7

Ix and MX and complications of cannabis use

Answer 7

Urine drug screen =there for 4weeks

mx- absitence
clinical experience suggest irregular use can be free from major issues

Acute -paranoia, anic attacks, accidents driving, and if susceptible can cause psychosis/schizprhenia
chronic - dysrythmias, anxiety/depression, amotivational syndrome

NO phsycal dependency