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Basic Drug Awareness Workshop
West Essex VTS
Bhags Sharma 2008
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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:
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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?
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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
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Opium (papaver somniferum)
Morphine
Diamorphine (heroin) semisynthetic
Methadone
L-alpha acetylmethadol (LAAM)
Dipipanone (diconal)
Codeine
Opiate receptors
• Mu μ
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Analgesia
Euphoria
Respiratory depression
Pupillary constriction
• Kappa κ
• Analgesia
• Dysphoria
• Depersonalisation
• Delta δ
• ?analgesia
• ?addiction
Opiate Withdrawal Syndrome
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Anxiety
Restlessness
Irritible
Craving
Yawning
Sweating
Eyes & nose streaming
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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
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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
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Erythroxylum coca
Used sniffing, IV, smoked
Rapidly absorbed
Primary reinforcer hence inherently addictive
Effects
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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
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Bhang infused
Ganja/Marijuana smoked
Hashish smoked
Skunk smoked
Cannabis oil
TCH 1%
TCH 2-8%
TCH 8-15%
TCH 8-20%
TCH 60%
Effects of cannabis
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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
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Harm reduction
Social skills training
Problem prioritising
Relaxation training
Anger management
Cognitive restructuring
Relapse prevention
Assessment of the drug user
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Mental state
Intoxication / withdrawal
Injecting
Complications
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Physical
Psychological
Social
Legal
• Physical examination
• Intention
• Drug screen