Transcript Drug Misuse in Primary Care

Introduction to Drug Misuse
Les Goldman
Objectives
• Gain basic knowledge of
• Common current patterns of drug misuse
• Local referral pathways
• Available treatments
Commonly misused drugs
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Cannabis - “draw” “weed”
Ecstasy, LSD
Solvents
Amphetamines - “whizz”
Opiates - “gear” “brown”
Cocaine - “crack” “rock” “stone”
Benzodiazepines - “blues”
Common patterns of drug misuse
• Primary heroin IV or inhaled plus
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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
Harmful effects result from
• Properties of drug
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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
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
Primary Care interventions assessment 2
• Objective confirmation
• History
• Examination
• Investigation
Primary Care interventions motivation
• Cycle of change - something to offer at each
stage
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Precontemplation
Contemplation
Action
Maintenance
Relapse
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 (don’t inject alone, learn basic CPR)
• Vaccination (hep A, hep B, tetanus)
Appropriate referral
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• Bridge Project (non-statutory)
• Counselling, harm reduction, needle exchange
• Activities (music, IT, gym, complementary therapies)
• Treatment
• Women’s Service
• Young People’s Service
• Stimulant Service
Appropriate referral
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• 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
Appropriate referral
• Specialist Services
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CDAT (Horton Park Centre)
One Stop Maternity Service
Young People’s 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
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
Principles of treatment 2
choice of opiate substitute
• Methadone
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Long acting
Can’t inject mixture
Sedating
Withdrawal sometimes difficult
• Buprenorphine (Subutex)
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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
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