Substance Abuse - Recreational Drug Abuse Flashcards
(85 cards)
1
Q
Number of people taking illicit drugs?Most common age group?
A
- 1 in 12 (1 in 3 for 16-24 yrs)
2
Q
Most common illicit drug to be taken?
A
- Cannabis most common
3
Q
Risk factors for illicit drug use?
A
o Young age, male gender o Low socioeconomic class o Psychiatric disorders o Impulsive personality o Genetic
4
Q
Origin, names, route and mechanism of illicit drug - cannabis?
A
- Produced from dried leaves, flowers and seeds of Cannabis sativa
- Called grass, marijuana, hash, dope, skunk
- Route – smoked, eaten, drunk
- Mechanism – Acts on specific cannabinoid receptor in CNS
5
Q
Origin, names, route and mechanism of illicit drug - volatile substances?
A
- Simple hydrocarbons such as acetone, toluene, butane have intoxicant properties
- Found in glue, solvents, lighter fuel, paint stripper, aerosols, paints, petrol, nail varnish
- Route – inhaled, sniffed
- Mechanism – rapidly absorbed, cause non-specific increased permeability of nerve cell membranes
6
Q
Origin, names, route and mechanism of illicit drug - cocaine?
A
- White powder produced from leaves of coca shrub
- Called – C, Charlie, Coke, Crack cocaine (pure), Snow
- Route – inhaled (snorted), smoked, injected
- Mechanism – Sniffed bypasses first-pass metabolism, local anaesthetic at mucous membranes, blocks neurotransmitter reuptake for dopamine, serotonin and noradrenaline
7
Q
Name the 4 stimulant drugs?
A
Cocaine, amphetamines, MDMA, Mephedrone
8
Q
Origin, names, route and mechanism of illicit drug - amphetamines?
A
- Sold as tablets or white powder – used in narcolepsy and ADHD
- Types - Crystal meth, speed, Ritalin (methylphenidate)
- Called – Whizz, speed, billy, uppers, dexxies
- Route – swallowed, inhaled or dissolved and injected
- Mechanism – Similarity to dopamine and noradrenaline so is CNS stimulant
9
Q
Origin, names, route and mechanism of illicit drug - MDMA?
A
- High profile links to dance music culture in the late 80s and early 90s
- Called – E, Eccies, MD, Mandy
- Route – Oral tablets
- Mechanism – Serotonin release and blocks reuptake
10
Q
Origin, names, route and mechanism of illicit drug - mephedrone?
A
- Closely related to speed and ecstasy
- Called – meow meow, M-CAT, White magic, MC
- Route – oral, nasal, inject
- Mechanism – Releases dopamine and blocks reuptake
11
Q
Name the 3 hallucinogen illicit drugs?
A
LSD, Magic Mushrooms, Ketamine
12
Q
Origin, names, route and mechanism of illicit drug - LSD?
A
- Occurs naturally in Morning Glory plant
- Called - Acid
- Route – impregnated on paper, tablets, powder
- Mechanism – Serotonin agonist and acts on serotonergic and dopaminergic systems
13
Q
Origin, names, route and mechanism of illicit drug - Magic mushroom?
A
- About 12 varieties with Liberty cap most common in UK
- Called - mushies
- Route – eaten raw, cooked, dried, drank
- Mechanism – Partial serotonin agonist
- Possession and consumption is not illegal unless prepared for illicit consumption
14
Q
Origin, names, route and mechanism of illicit drug - ketamine?
A
- Structurally like phencyclidine used as anaesthetic in vets
- Called – Special K
- Route – Sniffed powder
- Mechanism - NMDA antagonist - blocks glutamate
15
Q
Name the opiate illicit drugs?
A
Heroin - codeine, morphine, methadone, pethidine, buprenorphine
16
Q
Origin, names, route and mechanism of illicit drug - heroin?
A
- Derived from opium poppy – opiates, opioids are synthetic compounds- Street heroin usually 25-50% pure
- Called – Brown, Gear, Skag, Smack
- Route – brown powder in wraps, smoking (chasing), orally, snorted, IV and IM
- Mechanism – Opioid agonist, binds to endorphin receptors
17
Q
Name the 2 illicit depressant drugs?
A
Benzodiazepines, GHB
18
Q
Origin, names, route and mechanism of illicit drug - benzodiazepines?
A
- Therapeutic uses anxiolytics, hypnotics, anticonvulsants and muscle relaxants
- Short-acting (temazepam, oxazepam), medium-acting (lorazepam, alprazopam), long-acting (diazepam, nitrazepam, chlordiazepoxide)
- Called – Vallies, downers
- Route – oral, can be injected
- Mechanism – GABA agonist
19
Q
Origin, names, route and mechanism of illicit drug - GHB?
A
- Synthetic compound seen in dance settings
- Called – GBH, grievous bodily harm
- Route – liquid form
- Mechanism – GABA agonist
20
Q
Which illicit drugs are non-addictive?
A
o LSD, mushrooms, MDMA
21
Q
Describe the experimental pattern of illicit drug use?
A
o Explore effects
o Common and driven by availability and peer group
o Common for ‘softer’ drugs
22
Q
Describe the situational pattern of illicit drug use?
A
o Limited to certain situations (e.g. parties, raves)
o Mainly stimulants or hallucinogenic
23
Q
Describe the recreational pattern of illicit drug use?
A
o Regular but non-dependent use
o May be limited by period of life or may progress to dependent use
24
Q
Describe the polydrug pattern of illicit drug use?
A
o Non-dependent use of variety of drugs
o Risks can be addictive or multiplicative
25
Describe the dependent pattern of illicit drug use?
o Use of drug for which dependence syndrome developed
| o Continued use may be motivated by desire to avoid withdrawals
26
Effects of cannabis use?
* Effects act within minutes when smoked, reach a peak of 30 minutes and lasts 2-5 hours
* Mild euphoria, sense of enhance well-being, relaxation, increased appetite, talkative
27
Adverse effects of cannabis use?
- Mild paranoia, panic attacks, cravings, anxiety/depression, insomnia, psychosis, precipitates schizophrenia
28
Effects of volatile substance use?
• Euphoriant effects, disinhibition, slurred speech and blurred vision
29
Adverse Effects of volatile substances?
* Local irritation, headache, cardiac arrhythmias, unconsciousness, sudden death
* Liver and kidney damage, memory impairment
30
Effects of cocaine?
* Actions begin within a few minutes
| * Increased energy, confidence, euphoria and no desire for sleep, reduces hunger
31
Adverse effects of cocaine?
- Arrhythmias (MI), dry mouth, dilated pupils, tachycardia, anxiety, hypertension, impulsivity, impaired judgement
- Nasal septum damage, panic disorders, delusions, psychosis
32
Effects of amphetamines?
* Similar effects to cocaine but slower metabolism gives longer duration of action
* Active, alert, confident, chatty, no need for sleep, improved focus, full of energy, reduced appetite
33
Adverse effects of amphetamines?
- Tachycardia, tachypnoea, arrhythmias, hyperthermia, irritability, dilated pupils, quasi-psychotic state with hallucinations
- Panic attacks, depression, psychosis, dependency, chronic sleep deprivation
34
Come down effects of amphetamine use?
- Lethargy, anergic, anxiety, irritability, restless, unable to sleep
35
Effects of MDMA?
* Hallucinogenic and stimulant properties
* Effects start 30 mins after ingestion and tend to last 3-4 hours followed by gradual comedown
* Energy buzz, alert, alive, feelings of love for people around them
36
Adverse effects of MDMA?
- Dilated pupils, dehydration, tightening of jaw muscles, hyperthermia, tachycardia, increased sweating, nausea, vomiting, reduced potency despite increased sexual libido
- Anxiety, panic attacks, psychosis, paranoia
37
Come down effects of MDMA?
• Come down (24-48 hours)
| - Lethargy, anergia, anxiety, irritability, restless, unable to sleep
38
Effects of mephedrone?
• Feel alert, confident, talkative, euphoric, increased affection, reduced appetite
39
Adverse effects of mephedrone?
- Nausea, anxiety, vomiting, hallucinations, palpitations, seizures, reduced circulation, epistaxis, addiction, paranoia
40
Effects of LSD use?
* Effects act within 30 mins and last for 6 hours
| * Initial euphoria, hallucinations, sensory distortions and altered perceptions
41
Adverse effects of LSD?
- Nausea, anxiety, vomiting, hallucinations, palpitations, seizures, reduced circulation, epistaxis, addiction, paranoia
42
Effects of Magic mushrooms?
* Euphoria, lethargy, relaxed, perceptual and sensory changes, hallucinations
* Tolerance develops quickly
43
Adverse effects of magic mushrooms?
- D&V, dizziness, poisoning, depression, anxiety, panic attacks, bad trips, flashbacks
44
Effects of ketamine?
• Relaxation, altered bodily sensations, floating feelings, dissociation, altered perception, hallucinations
45
Adverse effects of ketamine?
- Nausea, ataxia, anaesthetic, amnesia, panic attacks
46
Effects of opiates?
• Warm feeling, euphoria, relaxed, analgesic, constricted (pin-point) pupils, untethering from worries or concerns
47
When does dependency develop in opiates?
• Opiate dependency develops in weeks and associated with withdrawal symptoms
48
Adverse effects of opiates?
- Constipation, nausea and vomiting, respiratory depression, loss of consciousness, injection site infections
49
Effects of benzodiazepines?
• Relaxed, calm, sedated, euphoric
50
What can develop in benzodiazepine use?
• Tolerance develops rapidly, and dependence develops over 4-6 weeks
51
Adverse effects of benzodiazepines?
- Respiratory depression, falls, hangover, memory loss, sedation, infection when injecting
- Impaired concentration, memory and mood
52
Effects of GHB?
* Euphoria, reduces inhibitions, drowsiness, intoxication
| * Effects start 15 minutes after ingestion
53
Adverse effects of GHB?
- Nausea, drowsiness, dizziness, agitation, visual disturbances, respiratory depression, unconsciousness, coma and death (mixed with alcohol)
54
What are the signs of dependence in illicit drug use?
* Tolerance
* Withdrawal symptoms
* Using more or for longer than intended
* Unsuccessful attempts to reduce
* Large time spent seeking, using and recovering from use
* Drug use taking priority
* Persistent use despite harm
55
What is the criteria for dependent drug use?
o >3 dependent signs in last 12 months
56
Withdrawal symptoms in cannabis? Management and advice given in cannabis use?
* Withdrawal Symptoms- Irritability, mood changes, nausea, loss of appetite, difficulty sleeping, shaking and sweating
* Illegal drug – reduce use and abstinence
* Don’t drive or operate heavy machinery
57
Management and advice given in volatile substances use?
* Education of users and ‘at risk’ groups
| * Most use will be experimental
58
Withdrawal symptoms in cocaine use?Management and advice given in cocaine use?
• Withdrawal symptoms
- Low mood, unwell, insomnia, psychological dependence
• Harm reduction advice (clean needle)
• CBT and treat co-morbid psychiatric illness
59
Withdrawal symptoms in amphetamine use?Management and advice given in amphetamine use?
• Withdrawal symptoms
- Lethargy, drowsiness, poor concentration
• Harm reduction advice
60
Withdrawal symptoms in MDMA use?Management and advice given in MDMA use?
```
• Withdrawal symptoms
- Lethargy, depression, memory problems
• Harm reduction advice
• Maintain hydration and avoid hypothermia
• Take breaks from dancing
```
61
Management and advice given in mephedrone use?
• Withdrawal symptoms
- Lethargy, drowsiness, poor concentration
• Harm reduction advice
62
Management and advice given in hallucinogens (LSD, mushrooms, ketamine) use?
* Harm reduction
* Maintain safe environment and avoid behavioural toxicity
* Acute psychosis managed with BDZ with expectant resolution
63
Withdrawal symptoms in opiates?
COWS scale- Tachycardia, sweating, restlessness, dilated pupils, bone aches, runny nose, diarrhoea, tremor, anxiety and insomnia, gooseflesh skin
64
Harm reduction advice given in opiate use?
- Don’t use alone or in combination with other drugs
- Avoid IV
- Needle exchange programmes
65
Safe injection advice given in opiates use?
- Use new sterile needles each time, sterile water, never share needles, syringes, spoon
- Rotate injection sites, avoid neck, breast, groin, infected areas
- Inject with blood flow
66
Symptomatic relief of opiate dependence?
a. Lofexidine (alpha-adrenergic agonist)
b. Loperamide (Tx diarrhoea)
c. Metoclopramide (Tx nausea, vomiting)
d. Ibuprofen
67
Substitute prescribing in opiate dependence?
Methadone – daily dose for observed administration
Long-acting synthetic opiate – half-life 24 hours so daily dose
Near saturation of opiate receptors so minimises reward of further consumption
Coloured liquid, drank, sugar-free option availableiv
Used in opiate withdrawal and maintenance
68
Alternative to methadone for substitute prescribing in opiate dependence?
Buprenorphine – once daily sublingual
Partial opiate agonist
Produces less euphoria than methadone
Treatment of drug dependence
69
Advice for maintenance prescribing in opiate dependence?
- Prevent under-dosing and overdosing
- Methadone and buprenorphine review monthly/supervised
- Aim to titrate up to maintenance dose then, look to dose reduce each fortnight for 4-6 months if possible
70
Drugs used to prevent relapse in opiate dependence?Drug used in opioid toxicity?
• Opiate relapse prevention- Naltrexone
Aid abstinence in formerly depedent patients
• Overdose- Naloxone IV
71
Withdrawal symptoms in benzodiazepines dependence?
• Withdrawal symptoms
| - Poor concentration, nausea, vomiting, tremors, headaches, anxiety, panic, depression, seizures
72
Substitute prescribing in benzodiazepines dependence?
Diazepam – taper off 1/8th dose per fortnight
73
General advice in benzodiazepines dependence?
- Do not operate heavy machinery
| - Needle advice and safe injecting
74
Drug used to treat overdose in benzodiazepines dependence?
- Flumazenil
75
Withdrawal symptoms in GHB dependence?
- Insomnia, anxiety, tremor, delirium
76
General management given to illicit drug users?
```
o Tailor to specific needs (residential, outpatient care or groups)
• Counselling
• Motivational therapy
• Cognitive therapy
• Family therapy
• Narcotics Anonymous
```
77
What advice should be given to IV drug users about risk?
o Educate about needle exchange, HIV, Hep C risk
• Safe injecting advice:
- Use new sterile needles each time, sterile water, never share needles, syringes, spoon
- Rotate injection sites, avoid neck, breast, groin, infected areas
- Inject with blood flow
78
Dependence on cannabis, amphetamines, MDMA, LSD, hallucinogens provides what legal issues?
* Loss of licence until 6-months (group 1) or 1-year (group 2) period of abstinence
* Medical assessment and urine screen may be required
79
Dependence on heroin, morphine, cocaine, methadone provides what legal issues?
* Loss of licence until 1-year (group 1) or 3-year (group 2) period of abstinence
* Independent medical assessment and urine screening needed
* May need consultant recommendation
80
Symptoms of overdose of opiates?
• Respiratory depression – death
81
Symptoms of overdose of cocaine?
• Tremor, confusion, seizures, arrhythmias, MI (common), cardiomyopathy
82
Symptoms of overdose of MDMA/Amphetamines?
• Arrhythmias, hypertension, stroke, circulatory collapse, seizures, coma
83
Symptoms of overdose of LSD?
• Rare – nausea and vomiting, autonomic overactivity, hyperthermia, coma
84
Symptoms of overdose of cannabis?
• Confusion, psychosis
85
Symptoms of overdose of BDZs?
• Over-sedations, coma, death, respiratory arrest
