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