Transcript Substance Misuse

Substance Misuse
Dr. Graham Roberts
Content
 Benzodiazepine management
 Alcohol screening and brief
intervention.
 Substance misuse update.
Benzodiazepine Management
 BNF section
4.1.2 Anxiolytics
Benzodiazepine anxiolytics can be effective in alleviating anxiety
states. Although these drugs are sometimes prescribed for stressrelated symptoms, unhappiness, or minor physical disease, their use
in such conditions is inappropriate. Benzodiazepine anxiolytics should
not be used as sole treatment for chronic anxiety, and they are not
appropriate for treating depression or chronic psychosis. In
bereavement, psychological adjustment may be inhibited by
benzodiazepines.
Anxiolytic benzodiazepine treatment should be limited to the lowest
possible dose for the shortest possible time. Dependence is
particularly likely in patients with a history of alcohol or drug abuse
and in patients with marked personality disorders.
Benzodiazepine Management
 Good drugs at what they are
prescribed for but not always
prescribed correctly.
 Potential for addiction and abuse.
 Street value.
 Interactions and risk of OD.
Benzodiazepine Management
 Management of street dependency:
 Stable on other drugs, no alcohol.
 Proven dependency.
 Titration and agreed reduction
 Long-term prescribed use.
 Cognitive impairment Vs Long term control.
 How to reduce different Benzos/ Z drugs.
Benzo conversion.
 Drug Dose equivilent to 5mg Diazepam:
 Chlordiazepoxide 15 mg
 Loprazolam 500 micrograms
 Lorazepam 500 micrograms
 Nitrazepam 5 mg
 Oxazepam 15 mg
 Temazepam 10 mg
 Zaleplon 10 mg
 Zopiclone 7.5 mg
 Zolpidem 10 mg
Benzodiazepine Management.
 Rate of Reduction :
 Approx 2mg per 2-4 weeks.
 Regular review.
 Establish Treatment Goals.