Substance misuse 1 - definitions and opioid misuse Flashcards
What is substance misuse?
Defined as the continued misuse of any psychoactive substance that is harmful or hazardous to a person’s wellbeing health, social situation and responsibilities
Dependence
State of depending on something/someone for support or to function/survive
For alcohol/drugs this implies a need for repeated doses of the drug to feel good, or to avoid feeling bad
Dependence syndrome: a cluster of behavioural, cognitive and physiological phenomena that may develop after repeated substance misuse, and includes a strong desire to take the drug, impaired control over its use, persistent use despite harmful consequences, a higher priority given to drug use than to other activities, increased tolerance and a physical withdrawal reaction when drug use is discontinued
Addiction
Repeated use of a psychoactive substance, to the extent that the user is periodically or chronically intoxicated, has great difficulty in voluntarily ceasing or modifying substance use and exhibits determination to obtain psychoactive substances by any means
Recreational abuse
Applies to non-prescribed medicines
Aims to achieve a pleasurable experience, helping a person to feel better during a bad time
Supported by peer pressure
Can include alcohol, tobacco, cannabis, heroin, cocaine and ecstasy
Involuntary addiction
Dependence which has arisen over time following initial legitimate prescribing
Sometimes occurs after hospital admission
Commonly misused substances
Heroin
Ecstasy
Cocaine
NPS’s
Cannabis
Amphetamine
GHB
Synthetic cannabinoids
Mephedrone
Khat
Laxatives/weight loss aids
Anabolic steroids
Melanotan
Gas and solvants
Links we can give to patients
Groups of misused substances
Effects of misused groups
Club/festivals Drug Wheel
How do people obtain misused substances?
Prescriptions
OTC sales
Unofficial internet supplies
Diverted supplies of prescribed medicines from friends, relatives and other people
Illegal street supplies of prescribed medicines and other substances
Diverted supplies of prescribed medicines in secure environments (eg, prison)
Other places, including private doctors, slimming clubs and gyms.
Stigma
A mark, condition or status that is subject to prejudice and discrimination by others
Manifests as a negative attitude against someone because of an attribute such as an illness, deformity, race, nationality or religion. People who use substances belong to the most stigmatised groups. This can impact upon their engagement with and access to services. HCPs, including pharmacy teams play a key role in reducing substance use related stigma, which may include challenging the views of their peers and other people who are accessing services
GPhC Standards for pharmacy professionals - =
Standard 1 (Pharmacy professionals must provide person-centred care - page 8)
Standard 3 (Pharmacy professionals must communicate effectively – page 10)
Standard 5 (Pharmacy professionals must use their professional judgement – page 12)
Standard 6 (Pharmacy professionals must behave in a professional manner – page 13)
Standard 7 (Pharmacy professionals must respect and maintain a person’s confidentiality and privacy – page 14).
Signs of opioid overdose
Pinpoint pupils
Loss of consciousness
Respiratory depression/breathing slows or stops
Extremely pale face that may feel clammy to the touch
Bluish purple tinge to lips or fingernails
Vomiting or making gurgling noises
Unable to speak
No response to noise/cannot be awakened
Routes of injecting substances- intravenous
Most popular method
Inject straight into the vein – rapid and efficient substance transition into the brain with an immediate and intense psychoactive effect
Elbow pit is the most common injecting site
When venous access becomes more difficult, people will move to a more ‘riskier’ site e.g. femoral vein in pelvic region, between fingers and toes
Opioids and stimulants (most common injected in this way)
routes of injecting substances - intramuscular
Delivers the substance into the muscle which then goes into general circulation through the muscle’s blood supply
Takes longer for the substance to reach the brain and exert its effect
May reduce the risk of overdose and increase the half-life of the substance
Image enhancing drugs e.g. steroids
routes of injecting substances - subcutaneous
Administration of the substance in the layer between the skin and the muscle tissue
Route lowers absorption and can lead to skin infections
Opioids, stimulants, sometimes steroids (Can be given in this way)
Formulations of injecting illicit substances
‘Street’ powders are mixed with water. Heroin has to be dissolved using citric or ascorbic acid. Street drugs are often ‘cut’ (contaminated) with other substances, therefore, impurities have to be filtered out (before injected).
Ampoules and vials with liquid are ready to inject. Those with powder would have to be mixed with water
Tablets are crushed and mixed with water
Capsules are opened and content mixed with water
Problems with poor injection techniques
Infections/overdose
Repeated injecting in same site – ulceration, abscesses, collapsed veins
Injected particles not fully dissolved – blockages in veins, kidney problems, thrombosis
Injection into groin – increased risk of hitting femoral artery or femoral nerve
Needle not at 45 degrees and not in the direction of blood flow for IV injection – vein damage
Blood borne viruses e.g.Hepatitis A, B, C, Infective endocarditis, candidiasis, HIV
Pain at site
Damage to blood vessels and peripheral nerves
IV INJECTION PROBLEMS
Phlebitis (inflammation of the vein), air embolism (gas bubble trapped in a blood vessel that blocks it), infiltration (leaking of the fluid into the tissue surrounding the vein)
SC injection problems
Lipohypertrophy (abnormal accumulation of fat under the surface of the skin)
Oral health problems - direct problems linked to specific substances
Users are more likely to smoke – increased risk of periodontal diseases, tooth loss, poor wound healing
Opioid and stimulant use – dry mouth – dental cavities
Opioid use – mask dental pain – delay in treatment
Consuming alcohol – dental caries, tooth erosion, periodontal disease
Stimulants – jaw clenching, teeth grinding
Methadone – very acidic – leads to tooth erosion
Oral health problems - indirect effects
Users less likely to have good oral hygiene practices and less likely to see a dentist
Dental practices reluctant to treat patients with substance misuse issues due to previous bad experience
Poor nutrition and irregular eating habits
Increased intake of sugary foods and refined carbohydrates in general but also associated with opioid use
