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 • Sneezing
• Restlessness • Nausea
• Irritible • Abdominal cramps
• Craving • Diarrhoea
• Yawning • Backaches
• Sweating • Goose flesh
• Eyes & nose streaming
 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 TCH 1%
• Ganja/Marijuana smoked TCH 2-8%
• Hashish smoked TCH 8-15%
• Skunk smoked TCH 8-20%
• Cannabis oil 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