Introduction to Drug MisuseIntroduction to Drug Misuse

Les GoldmanLes Goldman

ObjectivesObjectives

• Gain basic knowledge of • Common current patterns of drug misuse

• Local referral pathways

•Available treatments

• Gain basic knowledge of • Common current patterns of drug misuse

• Local referral pathways

•Available treatments

Commonly misused drugsCommonly misused drugs

• Cannabis - “draw” “weed”

• Ecstasy, LSD

• Solvents

• Amphetamines - “whizz”

• Opiates - “gear” “brown”

• Cocaine - “crack” “rock” “stone”

• Benzodiazepines - “blues”

• Cannabis - “draw” “weed”

• Ecstasy, LSD

• Solvents

• Amphetamines - “whizz”

• Opiates - “gear” “brown”

• Cocaine - “crack” “rock” “stone”

• Benzodiazepines - “blues”

Common patterns of drug misuseCommon patterns of drug misuse

• Primary heroin IV or inhaled plus•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

• Primary heroin IV or inhaled plus•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 fromHarmful effects result from

• Properties of drug• 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

• Properties of drug• 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

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

• 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

Primary Care interventions -assessment 2

• Objective confirmation• History

• Examination

• Investigation

• Objective confirmation• History

• Examination

• Investigation

Primary Care interventions - motivation

Primary Care interventions - motivation

• Cycle of change - something to offer at each stage• Precontemplation

• Contemplation

•Action

•Maintenance

• Relapse

• Cycle of change - something to offer at each stage• Precontemplation

• Contemplation

•Action

•Maintenance

• Relapse

Primary Care interventions - harm reduction

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)

• 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 1Appropriate referral 1

• 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

• 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 2Appropriate referral 2

• 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

• 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 3Appropriate referral 3

• Specialist Services• CDAT (Horton Park Centre)• One Stop Maternity Service• Young People’s Service• Day Care• Detoxification programmes

• Other services• Carers• Self help (Narcotics Anonymous)

• Specialist Services• CDAT (Horton Park Centre)• One Stop Maternity Service• Young People’s Service• Day Care• Detoxification programmes

• Other services• Carers• Self help (Narcotics Anonymous)

Criminal Justice and DrugsCriminal Justice and Drugs

• Drug Intervention Programme (DIP)

• Restriction on Bail (ROB)

• Drug Treatment & Testing Order (DTTO)

• Support workers

• Structured activities

• Drug Intervention Programme (DIP)

• Restriction on Bail (ROB)

• Drug Treatment & Testing Order (DTTO)

• Support workers

• Structured activities

Principles of treatment 1

choice of interventionPrinciples 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

• 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

Principles of treatment 2 choice of opiate substitute

• Methadone• Long acting• Can’t inject mixture• Sedating• Withdrawal sometimes difficult

• Buprenorphine (Subutex)• 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

• Methadone• Long acting• Can’t inject mixture• Sedating• Withdrawal sometimes difficult

• Buprenorphine (Subutex)• 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 informationMore 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

• 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