Basic Drug Awareness Workshop

West Essex VTSBhags Sharma 2008

• Introduction• Basic drug awareness• Management of the drug client• Cycle of change• Case scenarios

• Divide into 8 groups• Answer the following questions for each group:– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

• Heroin• Cocaine• Amphetamine• Benzodiazepines• Cannabis• MDMA• Nitrates • Nicotine

Heroin

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Opiates

• Opium (papaver somniferum)• Morphine• Diamorphine (heroin) semisynthetic• Methadone• L-alpha acetylmethadol (LAAM)• Dipipanone (diconal)• Codeine

Opiate receptors

• Mu μ• Analgesia• Euphoria• Respiratory depression• Pupillary constriction

• Kappa κ• Analgesia• Dysphoria• Depersonalisation

• Delta δ• ?analgesia• ?addiction

Opiate Withdrawal Syndrome

• Anxiety• Restlessness• Irritible• Craving• Yawning• Sweating• Eyes & nose streaming

• Sneezing• Nausea• Abdominal cramps• Diarrhoea• Backaches• Goose flesh

Pharmacotherapies• Opiate agonists

• Methadone• Diamorphine

• Partial opiate agonist • Buprenorphine

• Alpha 2 adrenergic agonists • lofexidine • clonidine

• Opiate antagonists • naloxone • naltrexone

• Combination• ‘suboxone’

Pharmacology of methadone

• Mu recpetor agonist• High oral bioavailability• Half – life with repeated dosing around 24

hours• Hepatic metabolism

Pharmacology of buprenorhine

• Partial mu agonist• High affinity for receptors• Displaces a full agonist• Blocks effect of additional opiates• Long half life• Peak plasma levels 1.5 – 2 hrs post dose• Sublingual tablet

Naltrexone

• Relapse prevention• ‘aversive’• implants

Cocaine

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Cocaine

• Erythroxylum coca• Used sniffing, IV, smoked• Rapidly absorbed• Primary reinforcer hence inherently addictive

Effects

• CNS stimulant (5 HT & DA reuptake inhibitor)• Local anaesthetic• Pupillary dilatation• Vasoconstriction• Psychosis ‘cocaine bug’• Raised BP, arrhythmias, seizures, cardiac

arrest

Amphetamine

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Benzodiazepines

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Cannabis

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Cannabinoids

• Cannibis sativa• Δ-9-tetrahydrocannabinol (TCH) is the active

ingredient• Quickly absorbed in the lung mucosa• Highly lipid soluble• Metabolised to 11-THC

Different formulations

• Bhang infused TCH 1%• Ganja/Marijuana smoked TCH 2-8%• Hashish smoked TCH 8-15% • Skunk smoked TCH 8-20%• Cannabis oil TCH 60%

Effects of cannabis

• Euphoria• Reddening of the eye• Hunger• Flashbacks• Amotivational state• Psychosis

MDMA

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Nitrates

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

Nicotine

– Other names for the drug– What type of drug is it?– How is it used?– What are its effects?– What are the problems associated with the drug?– Withdrawal phenomena?– How would you treat the addiction to this drug?

http://www.nta.nhs.uk/publications/documents/clinical_guidelines_2007.pdf

Models of Care

• Tier 1 services– Non substance misuse specific services requiring interface

with drug and alcohol treatment

• Tier 2 services– Open access drug and alcohol treatment

• Tier 3 services– Structured community based treatment services

• Tier 4 services– Residential services for drug and alcohol misuers

Harm reduction

• Advice directed at use of safer drugs or safer routes of administration

• Advice regarding safer injecting practice• Advice regarding safe sex• Prescription of maintenance opiates or

benzodiazepines• Assessment and treatment of comorbid physical or

mental illness• Engagement with other sources of help (e.g. social

work, housing)

Harm reduction• Use new sterile needles and syringes on each occasion (give

details of local needle exchange services if available)• Never share needles and syringes, spoons or filters with

another user• Rotate injection sites• Avoid injecting into neck, groin or breast• Avoid injecting into infected areas• Ensure that the drug is completely dissolved before injecting• Always inject with not against the blood flow• Do not take heroin while alone

Keyworking

• Harm reduction• Social skills training• Problem prioritising• Relaxation training• Anger management• Cognitive restructuring• Relapse prevention

Assessment of the drug user• Mental state• Intoxication / withdrawal• Injecting • Complications

• Physical• Psychological• Social• Legal

• Physical examination• Intention• Drug screen