Drugs of Dependency Dr Linda Harris Wakefield Integrated Substance Misuse Services WISMS.
Post on 18-Dec-2015
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OBJECTIVES
Substances of abuse and their physical and
psychological effects
Dependency syndrome An overview of treatment models
Major Drug Groups
All drugs fall into one of three groups:
Depressants: – slow you down, produce feelings of euphoria
Stimulants – speed you up, boost your energy and confidence
Hallucinogens – alter perception of the world
Opiates
Main drugs of abuse in UK Derivative of OPIUM found in poppy
plant The euphoric and analgesic effects
thought to lead to abuse Side effects - nausea, constipation,
respiratory depression
How are opiates taken
1. Injecting through a vein2. Swallowing in tablet form3. Smoking in cigarette form4. Smoking by inhaling the fumes
produced by burning powder in a foil – “chasing the dragon”
5. Sold in “bags” – 1 bag = 0.2gms = £10
Cocaine
Stimulant drug extracted from the leaves of the coca plant
Made into a crystalline salt form by adding sulphuric acid and finally ends up as cocaine hydrochloride powder
To make crack the powder is heated up in a microwave with bicarbonate of soda and water
Crack is easily melted and vapourised so it can be smoked
Crack may also be injected by mixing it with water and weak acid such as citric or ascorbic
Cocaine
Effects: feelings of increased energy with consequent increased activity and improved social confidence. users feel more alert and energetic, confident, physically strong with a higher mental capacity
Physical effects – dry mouth, sweating, loss of appetite, increased heart and pulse rate
Side Effects: - irritability, paranoia, restlessness, psychosis
Cocaine - How is it used
Dabbing – rubbed on the gums Snorting – most commonly in its hydrochloride
powder form Piping – smoked through a pipe Injecting - Chasing – chased on tin foil like heroin Smoking/chipping – flaking bits of cocaine or crack
into the top of a cigarette “joint” “Speedballing”
Powder cocaine –“champagne image” Crack – smokeable “rocks”
– More likely to be associated with mental and physical health problems
– Poly drug users– Links with criminality and violence
Costs – powder upwards of £40 per gram
- £5 - £10 per rock
Harm (Psych)
Anxiety and depression Drug related psychotic illnesses Aggravation of pre existing psychological or
psychiatric illness (“Dual Diagnosis”) Practically any mental disorder you can think
of
Harm (physical)
STD, unplanned pregnancy, Cx cancer Asthma Ear wax DVT, vascular damage Bacterial abscesses, metastatic sepsis Cl. novyii, botulinum, tetani HCV, HBV, HIV Overdose, death
Harm (Social)
Unemployment, poverty Crime: theft, dealing, physical violence,
prostitution, murder Imprisonment Separation, divorce, children in care,
loneliness and isolation Loss of dignity and self respect
Amphetamines
Synthetic stimulants
Most commonly produced in tablet or powder form and can be swallowed snorted injected or smoked
Mimic the effects of adrenalin in the body and therefore produce: - Increased energy, talkativeness, reduced appetite, restlessness, agitation
Amphetamine abuse
Side effects occur after prolonged use and when the effects of the drug wears off.
Depression Irritability Hunger Fatigue Vein damage in injectors Sexually transmitted diseases Acts of violence
1.
Benzodiazepines
Depressant, synthetic drugs Highly dependent with tolerance to their effects
building up rapidly
. Symptoms of withdrawal include: -· Anxiety and insomnia
Nausea and vomiting· Phobias· Loss of confidence and paranoia· Headaches and dizziness· Palpitations
Cannabis
This is a naturally occurring hallucinogenic drug most commonly seen in a variety of herbal forms or as a resin.
It produces the following effects: · Euphoria· Increased confidence· Altered sensory perceptions· Feeling of well being· Relaxation
Cannabis - the health risks
There is now established evidence that it produces dependence
Studies suggest the risk of dependency equates with that of alcohol
Cannabis is an intoxicant – impairs short term memory, judgement and co ordination – RTAs
Psychotic episodes have been reported (recent papers suggests increased risk particularly in patients with premorbid mental health issues)
Increased risk of chromic bronchitis and squamous metaplasia - ? Links with lung cancer
Cannabis – the health benefits
Used as a medicament for over 5,000 years Clinical trials underway exploring its use as
treatment for nausea and vomiting, combating muscle spasm in multiple sclerosis, treating loss of appetite and weight loss in AIDS
Drug companies looking at synthetic cannabinoids with therapeutic effects minus the psychoactive effects
Cannabis - the policy options
Relaxation on prohibition: -Potential reduction in crime and therefore
police and criminal justice expenditureReduction in prison overcrowdingPotential increase in use leading to as yet
unknown health implicationsSociety’s covert message – leading to
massive increases in use
Risk factors for substance misuse
Male Young Early childhood conduct disorder Childhood neglect Homeless Poor academic achievement
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1600080 82 84 86 88 90 92 94 96
Heroin
Methadone
New Notifi cations f orHeroin Addiction U.K. (1980-1996)
Estimated 600,000 class A drug users in the UK = 1% of the population ( ie 18 per GP)
Est 300,000 Hepatitis C positive Est 3 billion derived from prostitution Massive implications, chldcare, criminal
justice, social services acute care
Government Targets
Reduce the proportion of people under 25 using heroin and cocaine by 25% by 2005 and by 50% by 2008
Reduce the levels of repeat offending amongst drug misusing offenders by 25% by 2005 and 50% by 2008
Increase the participation of problem drug misusers including prisoners in drug treatment programmes by 66% by 2005 and 100% by 2008
National Government Policy
1998 – “Tackling Drugs to Build a Better Britain”
Ten year plan 4 key objectives: -
– Young people– Improve quality and access to treatment– Breaking the drugs crime link– Stifling availability of drugs on the streets
Emphasis on Breaking the Link Between Drugs and Crime
UK Crime and Disorder Act – Drug Treatment and Testing Orders– Arrest Referral schemes– Prison throughcare and aftercare -
Drugs Intervention Programme
Key messages
£1 spent on treatment saves £9.50 in terms of crime
Treatment works The longer in treatment the better the
outcome Complications kill Harm reduction saves lives
Graph showing deaths, comparing untreated patients with those in Methadone maintenance treatment in the Swedish study (15).
(Reproduced from Gronbladh et al)
Treatment
Attract Assess Retain Appropriate Care
Substitution Treatment Harm reduction Hepatitis B
immunisation Address homelessness Address skills deficits “Safer stronger
communities”
Treating 10 heroin users with methadone for 1 year
can save 2 lives
Treating 100 hypertensives for 10 years might save 2 strokes
Models of Care Treatment Tiers
Tier 1 – Non Substance misuse specialist Tier 1 – Non Substance misuse specialist services e.g. GP surgeries, Walk in centre services e.g. GP surgeries, Walk in centre A and EA and E
Tier 2 – Open access substance misuse Tier 2 – Open access substance misuse services – light touch services or services services – light touch services or services to encourage more engagement with to encourage more engagement with specialist servicesspecialist services
Tier 3 – Structured Community Services Tier 3 – Structured Community Services providing only within a structured and providing only within a structured and planned treatment settingplanned treatment setting
Tier 4a – Residential substance misuse Tier 4a – Residential substance misuse Tier 4b – Highly specialist non substance Tier 4b – Highly specialist non substance
misuse services – e.g. forensic services misuse services – e.g. forensic services liver units eating disorder units etcliver units eating disorder units etc Tier 1
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Good Medical Practice in managing dependency
Recognise the problem? Identify the complications of drug misuse and assess
risk taking behaviour Reduce harm e.g. hepatitis screening and vaccination Work with the patient to identify their needs and
identify a way of meeting those needs Work as part of a multidisciplinary team Think of social and psychological needs as well as
medical needs
Treatment – The evidence
Successful medical treatments aim to provide a safe substitute for the opiate heroin.
By prescribing an alternative or substitute one can alleviate withdrawal symptoms and the addict is released from the compulsion to carry out risk taking behaviour as part of their addiction.
Methadone remains the gold standard
Methadone
The evidence- most widely used form of opioid replacement therapy
in the US, Europe and Australia- Most evidence of impact on illicit drug use,and
criminal acts- Most positive evidence of containment of HIV
transmission- Most positive evidence of improvement in health,
employment status and social well being goals
Substitution
D etoxifica itonC an u se op ia tes o r n on op ia tes
N eed to b e w e ll m o tiva tedTen d s n o t to b e e ffec tive
L on g er te rm M a in ten tan ceN eed to b u ild in reg u la r review s
B ew are o f d ru g d ive rs ion
S h ort te rm m a in ten acen eM eth ad on e
B u p ren orp h in e
S u b s titu t ion
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