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Trainer Notes & Activities Overview KEY POINTS 1. The term ‘Party Drugs’ refers to a diverse group of drugs with a range of psychoactive effects; usually used on an occasional basis in a recreational setting, (e.g., dance parties or pubs). The most popular drug in this group is ecstasy; other drugs referred to as party drugs include ketamine, GHB and LSD. 2. While ecstasy has many similarities to amphetamines, its particular effects (especially its hallucinogenic properties), the social characteristics of its use and its clear association with the party drug scene places it within the group termed ‘party drugs’. 3. For those in the ‘party drug scene’, polydrug use is common and considered the ‘norm’. 4. Short-term harmful effects from ecstasy (MDMA) and other psychostimulants may result in catastrophic events (e.g., hyperthermia and rhabdomyolysis). Serotonergic neurotoxicity (resulting in problems such as impaired cognitive functioning) may be a consequence of long-term psychostimulant use. 5. Patients who use party drugs are most likely to present to GPs for assistance related to overdose, or to deal with the after-effects of party drug use. SUGGESTED OBJECTIVES To enable GPs to: identify the effects and consequences of ecstasy and party drug use and associated harms apply skills gained in other topics (such as Assessment, Brief Intervention, and Psychostimulants) to assess and respond to the harms associated with ecstasy and party drug use identify and implement harm reduction strategies relevant this group of psychoactive drugs identify, treat and refer patients with problems requiring specific care, such as overdose, cardiac or haematological problems. Please check that these objectives are relevant for the particular group you are about to train. If not, write down alternatives. Resource Kit for GP Trainers on Illicit Drug Issues Part B4 Drugs: Ecstasy & Party Drugs PAGE 1 4.4: ECSTASY & PARTY DRUGS Ecstasy & Party Drugs Topic Contents SLIDES The slides with slide notes cover concepts related to: different types of party drugs (ecstasy, ketamine and PCP, GHB (Fantasy), PMA (paramethoxyamphetamine), LSD and Psilocybin), their effects, prevalence and patterns of use pharmacology harms associated with use of party drugs assessment and intervention (GP responses to overdose and reducing harms). The slides are on the Resource Kit CDROM under this topic. Trainers are encouraged to select and/or adapt this slide set to meet the focus of the training and information needs of participants. ACTIVITIES The activities, along with those described in B3 Clinical Process and B4 Drugs: Psychostimulants, provide opportunities for GPs to: identify issues related to the use of ecstasy and party drugs within the general practice context identify relative benefits and harms associated with the use of ecstasy and other party drugs plan and implement harm reduction strategies specific to the use of ecstasy and party drugs. PAGE 2 Resource Kit for GP Trainers on Illicit Drug Issues Part B4 Drugs: Ecstasy & Party Drugs Please refer to the Resource Kit CDROM for a copy of handouts in PDF and Word. Slides, Activities & Handouts from other topics may be useful. Please refer to Part A3 for: Examples of Potential Links to Other Slides, and for a Listing of Activities and Handouts. Resource Kit for GP Trainers on Illicit Drug Issues Part B4 Drugs: Ecstasy & Party Drugs PAGE 3 4.4: ECSTASY & PARTY DRUGS HANDOUTS 1. DICH FactSheet: Ecstasy Drug Info Clearinghouse no date, Ecstasy, Australian Drug Foundation, Victoria, http://www.druginfo.adf.org.au/article.asp?id=2317&ContainerID=459#what 2. DICH FactSheet: GHB Drug Info Clearinghouse no date, GHB, Australian Drug Foundation, Victoria, http://www.druginfo.adf.org.au/article.asp?id=2318&ContainerID=459 3. DICH FactSheet: LSD/Hallucinogens Drug Info Clearinghouse no date, Hallucinogens, Australian Drug Foundation, Victoria, http://www.druginfo.adf.org.au/article.asp?id=2321&ContainerID=459 4. DICH FactSheet: Club Drugs Drug Info Clearinghouse no date, Club Drugs, Australian Drug Foundation, Victoria, http://www.druginfo.adf.org.au/article.asp?id=6066&ContainerID=563 Sources of Additional Information PATIENT RESOURCES NDARC 2000, Club Drugs. National Drug and Alcohol Research Centre, Sydney. NDARC no date, Ecstasy: Facts and Fiction, National Drug and Alcohol Research Centre, Sydney. Copies of these booklets are available from NDARC phone: (02) 9385 0333 or fax (02) 9386 0222. Patient resources are a valuable GP tool in the clinical setting. They can be obtained through ADIS or the publisher – free or at nominal cost. KEY READINGS Alliance of NSW Divisions GP Liaison Project, Tip Sheet Series, www.answd.com.au. Ecstasy: a general information guide for the General Practice setting. Please refer to Tip Sheets specified in 4.6: Psychostimulants. Latt, N., White, J., McLean, S., Lenton, S., Young, R., & Saunders, J. 2002, ‘Central Nervous System Stimulants’ in Hulse, G., White, J. & Cape, G. (eds.) 2002, Management of Alcohol and Drug Problems, ch. 8, Oxford University Press, South Melbourne, pp.124–140. NCETA (National Centre for Education and Training on Addiction) 2003, ‘Ecstasy’ and ‘Other Drugs’, Alcohol and Other Drugs: A Handbook for Health Professionals, chs. 7 & 12, Commonwealth Department of Health and Ageing, Canberra. White, J., Martin, J., Drum, H., McLean, S., Young, R., & Saunders, J. 2002, ‘Hallucinogens’ in Hulse, G., White, J. & Cape, G. (eds.) 2002, Management of Alcohol and Drug Problems, ch. 12, Oxford University Press, South Melbourne, pp. 229–239. Please refer to Topic 4.6 Psychostimulants for Additional Resources. PAGE 4 Resource Kit for GP Trainers on Illicit Drug Issues Part B4 Drugs: Ecstasy & Party Drugs Activity 1: Issues to do with Ecstasy Use PURPOSE To identify issues related to the use of ecstasy and party drugs in an emergency. PROCESS 1.1 Divide participants into small groups 1.2 Provide them with Case Monica (below, or a similar case provided by participants) 1.3 Instruct participants to discuss: first impressions and possible initial responses assessment / examination issues response to the patient response and advice for the parents what are the legal issues related to police attendance at an overdose? 1.4 Advise groups that they may qualify their responses by indicating what else they would like to know about the patient in reaching their decision 1.5 Bring the groups back and discuss contributions. CASE: MONICA You are working for a locum service and receive a phone call in the early hours of Monday morning from the parents of a young woman, Monica, seeking your urgent attendance at their home unit. They report that Monica has been vomiting for the last hour, appears somewhat confused and needed to urinate but was having difficulty, therefore was experiencing significant abdominal pain. They haven’t seen much of her over the weekend as she usually goes out, but tonight were awoken by her distress. They were reluctant to call an ambulance, as they thought she may have dabbled in drugs and feared police involvement. Resource Kit for GP Trainers on Illicit Drug Issues Part B4 Drugs: Ecstasy & Party Drugs PAGE 5 4.4: ECSTASY & PARTY DRUGS Ecstasy & Party Drugs Activities Additional case studies are in Hulse, G. (ed.) 2004 ‘Cannabis, Hallucinogens, and CNS Stimulants’ Alcohol and Drug Problems: A Case Studies Workbook, ch. 3, pp. 61–98 The above page reference provides cannabis, hallucinogens, and CNS stimulants case studies. These cases address issues related to young people, injectionrelated harms, harm reduction, drug-seeking behaviour, and treatment and management issues. Full citation: Johnson, S., Martin, J., Liew, D., Cape, G., Edmonds, C., Baigent, M., Dunn, C., Bucci, S., Baker, A., & Cohen, M. 2004, ‘Cannabis, Hallucinogens, and CNS Stimulants’ in Hulse, G. (ed.) 2004, Alcohol and Drug Problems: A Case Studies Workbook, ch. 3, Oxford University Press, South Melbourne, pp.61-98. Activity 2: Harm Reduction and Party Drugs PURPOSE To identify key harm reduction principles associated with party drug use. PROCESS 2.1 Ask participants to brainstorm answers to one or more issues below and record responses (on a whiteboard): 2.2 Draw two columns on the whiteboard. in the first column, brainstorm key assessment issues that indicate party drug use in the second column, list harms to the individual associated with use of party drugs 2.3 List harms related to the use of party drugs in the short- (acute) and long-term, and strategies to reduce these harms 2.4 List simple advice that could be provided to patients who use party drugs to reduce harms related to the use of party drugs 2.5 List strategies or advice you could provide to parents who wanted to identify their children’s use of party drugs, and the strategies you would use to assist them to respond to their child’s (possible or actual) drug use. PAGE 6 Resource Kit for GP Trainers on Illicit Drug Issues Part B4 Drugs: Ecstasy & Party Drugs