What are the categories of drug abuse?
What types of drugs fall into the opiate category of drugs of abuse?
What drugs fall under the category of depressants as drugs of abuse?
What drugs fall under the category of stimulants as drugs of abuse?
What drugs fall under the category of hallucinogens as drugs of abuse?
What drugs fall under the category of other as drugs of abuse?
- Volatile substances
- Anabolic steroids
- "legal highs"
What is the main method of consumption of heroin?
What are the methods of taking heroin?
What is the mechanism of action of heroin?
Binds to specific receptors for which there are endogneous ligands (endorphines). The variety of receptors which it binds to produce euphoria, analgeia and anxiolytic effects.
What are the main effects of heroin use?
- Intense pleasure
What are the adverse effects of heroin use?
- Respiratory Depression
- Cough Reflex depression
Nausea and vomiting - increased labyrinthine sensitivity
Bradycardia and hypotension - decreased sympathetic flow
- Lowering of body temperature
Pupillary constriction - pinpoint and unreactive to light
- Snoring giving way to shallow breathing
- Respiratory arrest with a pulse
If someone was in respiratory arrest but still had a pulse, what could be the cause?
Opiate overdose - pathognomic
What complications are people at risk of when injecting drugs?
- Local abscess
- Bacterial endocarditis
- Viral infection - hep B, C, HIV
How long can it take for opiate dependency to occur?
Weeks of regular use
What are the effects of withdrawal of opiates?
- Muscle pain and cramps
- Increased salivation, nasala and lacrimal secretions
- Dilated pupils
- Nausea and vomiting, diarrhoea
What is the main method of administration of cocaine?
Inhalation - undergoes rapid first pass metabolism
What are the methods of administration of cocaine?
How does cocaine work?
Cocaine has a wide range effects potentiating dopamingeric, serotinergic and noradrenergic neurotransmission by blocking neurotransmitter reuptake. It's action occurs a few minutes after consumption
What are the effects of cocainse use?
- Increased energy
- Increase confidence
- Decreased need for sleep
- Decreased appetitie
Why is cocaine often taken repeatedly in one session?
Due to rapid metabolism - rapid high then subsequent dysphoria
What are the adverse effects of cocaine use?
- Intense anxiety
- Hypertension and CVA
- Acute impulsivity
- Nasal septum necrosis
- Toxic confusion
- Paranoid Psychosis
- Panic and anxiety disorders
What are the withdrawal effects of cocaine?
What are the methods of administration of amphetamines?
Powder - inhaled, swallowed, injected
How do amphetamines work?
Due to chemical similarity to noradrenaline and dopamine, it acts similarly to cocaine, but has longer lasting effects due to slower metabolism
What are the adverse effects of amphetamines?
- Post-use depression
- Toxic confusion with convulsions and death
- Amphetamine psychosis
What are the methods of adminstraion of MDMA?
How does MDMA work?
Causes serotonin release and blocks reuptake. It has similarities to mercaline and amphetamine, meaning that it has both hallucinogenic and stimulant properties.
How long does it take for MDMA to work?
About 30 minutes after ingestion
How long does the initial effect of MDMA last for?
What are the effects of MDMA?
- Feelings of increased camaraderie/closeness to others
- Pleasurable agitation - relieved by dancing
- Decreased fatigue
What are the acute adverse effects of MDMA?
- Increased sweating
- Nausea and vomiting
- Diminished potency despite increased libido
- Dehydration + hyperthermia
What are chonic adverse effects of MDMA use?
- Cognitive impairment
- Drug induced psychosis
What are the acute side effects of benzodiazepine use?
- Impaired concentration + co-ordination
- Limb ischaemia - IV users
What are chronic side effects of benzodiazepine use?
- Impaired concentration and memory
- Depressed mood
What is the mechanism of action of cannbis?
The THC compound found in cannabis binds to cannabinoid receptors in the CNS and peripheries. This has mood altering effects by potentiating signals from these receptors. It also appears to show weak opiod-like and barbituate-like effects
What are the modes of intake of cannabis?
Why does urine contain THC for up to 4 weeks after use of cannabis?
Metabolised drug dissovles into fat, where it is stored for prolonged periods and released slowly
What are the effects of cannabis?
- Sense of enhanced well-being
- Subjective sense of enhanced sensation
- Altered time sense
- Increased appetite
- Mild tachycardia, dysarthria and ataxia
What are some of the adverse effects of cannabis use?
- Mild paranoia
- Panic attacks
- Toxic confusion
- Respiratory problems associated with tobacco use
What mental illness can be triggered/relapse due to cannabis use?
What are the effects of anabolic steroid use?
- Muscle hypertrophy
- Increased training time and decreased recovery
- Increased energy levels
What are the adverse side effects of anabolic steroids?
- Skin - acne, stretch marks, baldness
- Hypogonadism, gynaecomastia
- Liver damage
- Emotional instability
What are legal highs?
Heterogenous group of psychoactive substances that are not controlled under the misuse of drugs act. A large proportion of them are against the medicines act. They often consist of plant-based and synthetic compounds with variable effects.
What is an example of a legal high?
Mephadrone - acts as a stimulant
When asking someone about current drug use, what would you ask them?
- Why have they presented now?
- What are they seeking help for?
- Pregnancy? - females
- What is their current drug use? - frequency and number, amount taken, route of intake
- Do they get withdrawal?
- Do they share equipment? - needles
When asking someone about past drug use, what would you ask about?
- Lifetime drug use - age of first use, changing pattern of use, periods of abstinence
- Complications of drug use
- Previous treatment/rehabilitation
When physically physically examining a drug user, what might you find?
- Weight loss
- Tooth decay
- SIgns of IVDU - phelbitis, abscess, old scarring
- Enlarged liver
- Signs of withdrawal
Once you have taken a full history, MSE and physical examination, what investigations would you perform in assessing a drug user?
- Urinary screening
- Blood testing - FBC, LFTs, HIV, Hep B/C
What are the different patterns of drug use?
- Recreational - non dependent
- Polydrug - non dependent
What are the side effects of benzodiazepine withdrawal?
- Seizure, delerium
What is the definition of acute intoxication?
A pattern of reversible physical and mental abnormalities caused by the direct effects of the substance
What is the definition of at-risk use?
Pattern of substance use where the person is at increased risk of harming their physical or mental health. This crosses from normal consumption to harmful use. It takes into account not only the amount used, but also the situations and behaviours associated with it.
What is the defintion of harmful use?
The continuation of substance use despite evidence of damage to the user's physical or mental heatlh or to their social, occupational and familial well-being.
What is the defintion of dependence?
Encompasses a range of features which includes physical dependence and pscyhological dependence. In some drugs, no physical dependence is seen.
What is the definition of withdrawal?
Where there is physical dependence on a drug, abstinence will generally lead to features of withdrawal of that drug, which are characteristic for each drug
What drugs are recognised for clinically significant withdrawal syndromes?
What is a substance-induced psychotic disorder?
Illness characterise by hallucinations +/- delusions occuring as a direct result of substance-induced neurotoxicity. Psychotic symptoms may occur during intoxication, withdrawal, or may develop on the background of harmful or dependent use
What drugs can are recognised to cause cognitive impairment syndromes?
- Volatile chemicals
What are the core features of the dependence syndrome?
- Narrowing of drug repertoire
- Difficulty controlling use
- Increased tolerance
- Psychological withdrawal on reduction of intake
- Persitence despite harmful consequences
What is dependence syndrome?
Clinical syndrome describing the features of substance dependence
What medications can be used for substitute prescribing when trying to ween someone off opiate drugs?
What medications can be used for opiate withdrawal?
- Lofexidine - alpha adrenergic agonist
- Loperamide - Diarrhoea
- Metoclopromide - Nausea and vomiting
- Ibuprofen - Heachaches and vomiting
How long does opiate withdrawal normally last?
What is the defintion of drug-induced psychosis?
Psychotic features which continue after the period of acute intoxication and withdrawal. These may be more typical to primary psychotic illnesses, and should be treated as for acute episodes of schizophrenia
What are psychotic features during drug intoxication characterised by?
Rapidly changing pattern of symptom type and severity and include visual hallucinations, sensory distortion/illusions, and persecutory/referential thinking. They charactersitically fluctuate hour to hour
What are psychotic features during withdrawal characterised by?
Some drugs (BDZ, alcohol, cocaine) can cause delerium during withdrawal in which variable psychotic features may be prominent. There may be visual or tactile hallucinations and poorly formed persecutory delusional ideas. Typically fluctuant
What is the defintion of tolerance?
Reduced responsiveness to a drug caused by previous administration
What are the mechanisms of tolerance?
- Dispositional tolerance
- Pharmacodynamic tolerance
What is the reward pathway in the brain?
- Neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex
- When VTA neurones are stimulated they release dopamine is released
- This causes a sensation of pleasure/reward
What substitute drug is used in BDZ dependency?
Long-acting diazepam - find lowest dose which will prevent withdrawal symptoms