MANAGEMENT OF POLY DRUG USE

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MANAGEMENT OF POLY DRUG USE

• DAVID YOUNG MEDICAL DIRECTOR
• LIGHTHOUSE PROJECT

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Poly Drug Use

• The concurrent use of multiple drugs
  (including alcohol), or the combining of drugs.
  It can occur in a range of patterns and for a
  variety of reasons, and may or may not involve
  drug dependence

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Is poly drug use new?

• Appears to be the norm amongst many drug users
• Users rarely limit their use to one drug
• Many users will have a primary drug of use which
  they will use alongside a range of other drugs
• Poly drug use is highly prevalent among
  individuals attending drug treatment services

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THEN Keith

• Brown Heroin
• Cannabis

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NOW - Apple

• Brown Heroin
• Crack Cocaine
• Benzodiazepines
• Cannabis
• Alcohol

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Common patterns of poly drug use can include

• Using drugs from Multiple drug types (no evidence
  of dependence on any one type of drug)
• Dependence on one drug type, but use of other
  drugs
• Dependence on several drugs or types of drugs

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Blind (Drug)Date

• Cocaine
• Crack Cocaine
• Amphetamine
• Heroin
• Other opiates and opioids
• Alcohol
• Benzodiazepines
• Cannabis
• LSD
• MDMA
• PIEDs

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Common Drug Interactions

• Opiates Alcohol Increased sedation and
  respiratory depression
• Opiates Benzodiazepines Alcohol Increased
  sedation and respiratory depression
• Opiates Alcohol Stimulants Increase in
  intoxication temporary decrease in sedation

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Risks from Polydrug use

• Increase risk of overdose from combining
  depressant type drugs
• Increase risk of overdose from combining
  depressant type drugs with stimulant drugs
• Increase in tendency to inject drugs
• Increase in the frequency of injecting
• Increase risk of blood borne viruses and physical
  damage
• Increase risk of unsafe sex

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Stimulant Issues

• Evidence Base
• Harm Reduction
• Contingency Management

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• No effective pharmacotherapy for cocaine
  dependence currently available (Am J Addict 2007
  1671-78
• Contingency management, in which patients receive
  desirable consequences contingent upon providing
  objective evidence of drug abstinence, is one of
  the most effective treatments for cocaine
  dependency (NICE)

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Conclusion

• Assess risk - Document risk Manage risk
• Brief Interventions/Harm Reduction
• Contingency management