Basic Drug Awareness Workshop

1. Basic Drug Awareness Workshop West Essex VTS Bhags Sharma 2008

2. Introduction • Basic drug awareness • Management of the drug client • Cycle of change • Case scenarios

3. 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?

4. Heroin • Cocaine • Amphetamine • Benzodiazepines • Cannabis • MDMA • Nitrates • Nicotine

5. 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?

7. Opiates • Opium (papaver somniferum) • Morphine • Diamorphine (heroin) semisynthetic • Methadone • L-alpha acetylmethadol (LAAM) • Dipipanone (diconal) • Codeine

8. Opiate receptors • Mu μ • Analgesia • Euphoria • Respiratory depression • Pupillary constriction • Kappa κ • Analgesia • Dysphoria • Depersonalisation • Delta δ • ?analgesia • ?addiction

9. Anxiety Restlessness Irritible Craving Yawning Sweating Eyes & nose streaming Sneezing Nausea Abdominal cramps Diarrhoea Backaches Goose flesh Opiate Withdrawal Syndrome

10. Pharmacotherapies • Opiate agonists • Methadone • Diamorphine • Partial opiate agonist • Buprenorphine • Alpha 2 adrenergic agonists • lofexidine • clonidine • Opiate antagonists • naloxone • naltrexone • Combination • ‘suboxone’

11. Pharmacology of methadone • Mu recpetor agonist • High oral bioavailability • Half – life with repeated dosing around 24 hours • Hepatic metabolism

12. 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

13. Naltrexone • Relapse prevention • ‘aversive’ • implants

14. 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?

15. Cocaine • Erythroxylum coca • Used sniffing, IV, smoked • Rapidly absorbed • Primary reinforcer hence inherently addictive

16. Effects • CNS stimulant (5 HT & DA reuptake inhibitor) • Local anaesthetic • Pupillary dilatation • Vasoconstriction • Psychosis ‘cocaine bug’ • Raised BP, arrhythmias, seizures, cardiac arrest

19. 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?

21. 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?

23. 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?

25. Cannabinoids • Cannibis sativa • Δ-9-tetrahydrocannabinol (TCH) is the active ingredient • Quickly absorbed in the lung mucosa • Highly lipid soluble • Metabolised to 11-THC

26. 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%

27. Effects of cannabis • Euphoria • Reddening of the eye • Hunger • Flashbacks • Amotivational state • Psychosis

28. 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?

30. 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?

32. 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?

34. http://www.nta.nhs.uk/publications/documents/clinical_guidelines_2007.pdfhttp://www.nta.nhs.uk/publications/documents/clinical_guidelines_2007.pdf

35. 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

36. 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)

37. 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

38. Keyworking • Harm reduction • Social skills training • Problem prioritising • Relaxation training • Anger management • Cognitive restructuring • Relapse prevention

39. Assessment of the drug user • Mental state • Intoxication / withdrawal • Injecting • Complications • Physical • Psychological • Social • Legal • Physical examination • Intention • Drug screen