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Substance Abuse and Misuse
Emergency Medical Response
Lesson 25: Substance Misuse and Abuse
You Are the
Emergency Medical Responder
Your emergency medical services (EMS) unit is
summoned to a residence on a report of an
unconscious person. When you arrive and size-up
the scene, you discover an older couple. The wife is
distraught and says that her husband had been
drinking alcoholic beverages heavily earlier in the
day. Shortly after taking his prescribed Valium®, she
says he became drowsy and incoherent, and then
collapsed. Unable to get him to respond, she called
9-1-1. On assessing the patient, you find that he is
unresponsive, his breathing is shallow and slow, his
heart rate is slow and his pulse is weak.
Emergency Medical Response
Substance Abuse and
Substance Misuse
 Abuse: The deliberate, persistent and excessive
use of a substance without regard to health
concerns or accepted medical practices
 Misuse: The use of a substance for unintended
purposes or for appropriate purposes but in
improper amounts or doses
 Includes use of illegal (or illicit or controlled)
substances and legal substances, such as
nicotine, alcohol and over-the-counter (OTC)
medications, such as sleeping pills and diet pills
Emergency Medical Response
Substance Abuse Terms
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Dependency – the desire to continuously use
Addiction – compulsive need for the substance
Withdrawal – stop using when addicted
Tolerance – effects on the body decrease
Overdose – excessive amount of the substance
Synergistic effect – two or more substances
used at the same time – can be fatal
Emergency Medical Response
Categories of Abused Substances
Stimulants – central nervous system
Hallucinogens – alters time and space
Depressants – central nervous system
Narcotics – act as a depressant
Inhalants – depresses the central nervous
system
 Cannabis products – impaired judgment and
motor coordination
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Emergency Medical Response
Stimulants
 Effects on the body:
 Increased physical
and mental activity
 Temporary feelings
of alertness
 Appetite
suppression
 Energy bursts
 Examples:
 Amphetamine,
dextroamphetamine,
methamphetamine
 Cocaine
 Crack cocaine
 Crystal meth
 Ice
 Speed
Emergency Medical Response
Stimulant Overdose
Signs and Symptoms
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Moist or flushed skin
Sweating, chills
Nausea or vomiting
Fever
Headache
Dizziness
Rapid pulse
Rapid breathing
High blood pressure
Chest pain
Possible respiratory
distress
 Excitability,
restlessness,
talkativeness or
irritability
 Possible sudden loss of
consciousness
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Emergency Medical Response
Hallucinogens
 Effects on the body:
 Changes in mood,
sensation, thought,
emotion and selfawareness
 Altered perception
of time and space
 Visual, auditory
and tactile
delusions
 Examples:
 Lysergic acid
diethylamide
Emergency Medical Response
 LSD “acid”
 Psilocybin
 mushrooms
 Phencyclidine
 PCP “angel dust”
 Mescaline
 peyote
Hallucinogen Abuse
Signs and Symptoms
 Sudden mood changes
 Flushed face
 Claims of seeing or hearing something not
present
 Anxiety or fear
Emergency Medical Response
Depressants
 Effects on the body:
 Decreased physical
and mental activity
 Altered level of
consciousness
(LOC)
 Depressed
respirations
 Impaired
coordination and
judgment
 Examples:
 Barbiturates
 Benzodiazepines
 Valium
 Ketamine
 Rohypnol
 roofies
 GammaHydroxybutyrate
(GHB)
 Alcohol
Emergency Medical Response
Depressant Abuse
Signs and Symptoms
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Drowsiness
Confusion
Slurred speech
Slow heart and breathing rates
Poor coordination
Emergency Medical Response
Alcohol Withdrawal
Signs and Symptoms
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Confusion and restlessness
Delirium tremens (DTs)
Hallucinations
Seizures
Emergency Medical Response
Narcotics
 Effects on the body:
 Depression
 Pain relief
 Examples:
 Morphine
 Codeine
 Heroin
 Oxycodone
Emergency Medical Response
Inhalants
 Effects on the body:
 Mood altering
 Depression of
central nervous
system
 Erratic blood
pressure and pulse
 Examples:
 Amyl nitrate
 Nitrous oxide
Emergency Medical Response
 Laughing gas
 Solvents
 Acetone
 Gasoline
Cannabis Products
 Effects on the body:
 Feelings of elation
 Distorted
perceptions of time
and space
 Impaired judgment
and motor
coordination
 Examples:
 Marijuana
Emergency Medical Response
 Pot, grass, weed
 Hashish
Signs of Cannabis and Inhalant Use
 Cannabis: red, bloodshot eyes
 Inhalants: drunken or disoriented appearance
(similar to hallucinogen abuse)
Emergency Medical Response
Other Substances
 Designer drugs
 Methylenedioxymethamphetamine (MDMA “ecstasy,” “E”)
 Anabolic steroids – juice, roids, vitamins
 OTC medications, such as aspirin, nasal
sprays
 Laxatives and emetics (ipecac)
 Anorexia Nervosa
 Bulimia
Emergency Medical Response
General Principles of Care
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Size-up the scene
Perform a primary assessment
Summon more advanced medical personnel
Perform a physical exam
Take a SAMPLE history to try to find out what
substance was taken, how much was taken and
when it was taken
Calm and reassure the patient
Keep the patient from getting chilled or overheated
Keep the patient’s airway clear
If the patient has difficulty breathing, administer
emergency oxygen, if available
Emergency Medical Response
Factors Contributing to
Substance Abuse
 Lack of parental supervision
 Breakdown of traditional family structure
 Wish to escape unpleasant surroundings and
stressful situations
 Widespread availability of substances
 Peer pressure and the basic need to belong
 Low self-esteem, including feelings of guilt or shame
 Media glamorization promoting the idea that using
substances enhances fun and popularity
 History of substance abuse in the home or
community environments
Emergency Medical Response
Prevention Guidelines and
Unintentional Misuse or Overdose
 Read the product information; use only as
directed
 Ask a doctor or pharmacist about intended use
and side effects; if taking more than one
medication, check for possible interaction effects
 Never use another person’s prescribed
medications
 Always keep medications in their original, marked
containers
 Discard all out-of-date medications
 Keep medications out of reach of children
Emergency Medical Response
You Are the
Emergency Medical Responder
Based on your findings, you suspect that the
patient ingested a combination of drugs and
alcohol.
Emergency Medical Response