Transcript Drug misuse and dependence

Drug misuse and
dependence
How did we get here?
• Recently finished VTS- leeds/bradford
• Interested in the field, work in a practice
with similarly minded doctors.
• RCGP part 1 and 2 courses.
Afternoon outline
• What do you want to know
• Try to answer some of this and give outline
of treatment in drug uses in UK
• Coffee break
• Some cases to discuss
• Expect to be in interrupted
Aims
• Increase understanding, awareness and
confidence in managing drug misusers
• Have framework to help deal with drug
users in surgery
• Knowledge of where to get help.
What do you want to know?
Some figures
• 141000 in treatment 2001/2
• 38% of 15yr olds used a drug in last year
• One study of 160 homeless 16-25yr olds
89% in last year (95% ever)
• 65% of all arrestees positive for some form
of drugs
• 1.2% mortality per year in heroin users
Classification of drugs
• Class A – cocaine, heroin, methadone,
morphine, PCP, ecstacy, LSD. Any injected
class B drug
• Class B – amphetamine, dihydrocodeine,
Ritalin, barbiturates
• Class C – cannabis, benzodiazepines
Another language
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Gear, brown, smack
Rocks, white, crack
Uppers, downers
Blues and yellows
Skunk?
The Drug Addict
• What do you think are the characteristics
of a stereotypical drug addict?
• Are all drug addicts the same?
Reasons for starting
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Peer group pressure
Enjoyment
Self manage mental health illness
Self manage chronic pain
Iatrogenic
Risk factors
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Prior delinquent behaviour
Social class
Peer group influences
Risk taking behaviour
Parental
• Poor quality of relationships
• Inconsistent parenting
• Lack of participation in conventional
activities eg employment and education
How do you feel??
Primary care role
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Assessment
Management
Education
Signposting
Aims of treatment
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Accessibility and health improvement
Harm minimisation
Reducing associated deaths
Reducing associated criminal activity
Appropriate treatment and referral
Improve social, personal and family fctn.
Assessment
• History – Why now? primary drug, present
problems, drug history, physical
symptoms, worries and concerns. Children
and other family members
• Examination – injecting sites, evidence of
DVT, general health inc dental. BMI
• Discuss options ahead
Presentation of substance misuse
in general practice
Local services
• Current treatment agencies in Bradford
• SMS (Fountains Hall), Ripple, NBPCT DS,
Bridge Project, Henry Street, CDAT
• GP surgeries inc Kensington St, Farrar
MC, Ling House
• Could change with new pct?
Management options
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Needle exchange
Methadone
Subutex
(dihydrocodeine)
Detox
Daycare
Rehabilitation
Sources of further information
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RCGP website
www.smmgp.org.uk
www.scan.uk.net
Drugscope
Loads of possibilities- a lot of independent
sites eg urban75