Introduction to Drug Misuse

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Introduction to Drug Misuse

• Les Goldman

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Objectives

• Gain basic knowledge of
• Common current patterns of drug misuse
• Local referral pathways
• Available treatments

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Commonly misused drugs

• Cannabis - draw weed
• Ecstasy, LSD
• Solvents
• Amphetamines - whizz
• Opiates - gear brown
• Cocaine - crack rock stone
• Benzodiazepines - blues

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Common patterns of drug misuse

• Primary heroin IV or inhaled plus
• Methadone, DHC etc when supplies low
• Benzodiazepines for depression
• Cocaine occasionally as treat
• Cannabis daily
• Primary cocaine use - intense binges plus
• Heroin and/or benzos afterwards
• Cannabis

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Harmful effects result from

• Properties of drug
• Hallucinogen - ecstasy, LSD
• Depressant - opiates, benzodiazepines
• Stimulant - amphetamine, cocaine
• Addictive potential
• Mode of administration
• Oral - overdose risk
• Smoked / inhaled - heat, tobacco, ash, toxic
  fumes
• Injected - overdose and infection risk, arterial
  injury, DVT
• Use in combination
• With other drugs
• With alcohol

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Primary Care interventions - assessment 1

• 5 areas
• Drug use (which drugs, quantity used, duration of
  use, mode of administration, experience of
  withdrawal and overdose, previous treatment)
• Physical health
• Psychological health
• Social circumstances (friends, family support,
  housing, work)
• Involvement with criminal justice system

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Primary Care interventions -assessment 2

• Objective confirmation
• History
• Examination
• Investigation

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Primary Care interventions - motivation

• Cycle of change - something to offer at each
  stage
• Precontemplation
• Contemplation
• Action
• Maintenance
• Relapse

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Primary Care interventions - harm reduction

• Accurate information about drug effects and risks
  
• Verbal
• Written
• Encourage safer pattern of use
• Care with combinations of drugs / alcohol
• Smoke rather than inject
• Safer smoking / injecting techniques
• Manage physical health problems
• Preventive health care
• Overdose prevention (dont inject alone, learn
  basic CPR)
• Vaccination (hep A, hep B, tetanus)

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Appropriate referral 1

• Bridge Project (non-statutory)
• Counselling, harm reduction, needle exchange
• Activities (music, IT, gym, complementary
  therapies)
• Treatment
• Womens Service
• Young Peoples Service
• Stimulant Service

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Appropriate referral 2

• PCT level primary care based services
• NBPCT Drug Service
• Ripple Project
• City SMS
• Personnel - GPwSI, CPN, physical health nurse,
  drugs worker, vocational advice, social support,
  carer support, community development
• Principally opiate dependence services
• Main exclusions
• Complex poly - substance misuse
• Serious mental health problems
• Young people

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Appropriate referral 3

• Specialist Services
• CDAT (Horton Park Centre)
• One Stop Maternity Service
• Young Peoples Service
• Day Care
• Detoxification programmes
• Other services
• Carers
• Self help (Narcotics Anonymous)

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Criminal Justice and Drugs

• Drug Intervention Programme (DIP)
• Restriction on Bail (ROB)
• Drug Treatment Testing Order (DTTO)
• Support workers
• Structured activities

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Principles of treatment 1 choice of intervention

• Substitute prescribing
• Appropriate for e.g. opiate and benzodiazepine
  misuse
• Harm reduction
• Physical
• Psychological
• Social
• Maintenance / detoxification
• Symptomatic relief
• Appropriate for e.g. cocaine misuse
• Relapse prevention
• Medical - naltrexone
• Non medical - supportive counselling

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Principles of treatment 2 choice of
opiate substitute

• Methadone
• Long acting
• Cant inject mixture
• Sedating
• Withdrawal sometimes difficult
• Buprenorphine (Subutex)
• Long acting
• Blocking effect (safer but risk of precipitate
  withdrawal on starting treatment)
• Less sedating
• Easier withdrawal
• Dihydrocodeine
• Easily diverted
• Easier withdrawal, useful for quick detox
• Less potent

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More information

• Drug Misuse and Dependence - Guidelines on
  Clinical Management DoH 1999
• www.smmgp.co.uk
• Guidelines and info
• www.drugscope.org.uk
• Easy to use source of information
• www.nta.nhs.uk
• DoH agency commissioning drug misuse services