Street Drug Update 2013

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Talk i gave at ICEN in Melbourne on Street Drugs - clinical update for the emergency nurse.

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Street Drug Update 2013

  1. 1. Street Drugs Kane Guthrie FCENA
  2. 2. Clinical Update • Synthetic canabinoids • Designer amphetamines • Nurofen plus abuse
  3. 3. Street Drugs - Australia ED’s biggest bain remains: – ETOH – Smoking Emerging concerns: – Prescription drug abuse – Synthetic derivatives of old
  4. 4. Street Drugs in ED • Resource intent • Challenging personas Stats: • Amphetamines in ED 1.2% presentations (Gray, 2007, MJA) • July 2010-12 Vic ambulance • 318% increase in amphetamine related call outs • (Helibourne, 2013, MJA)
  5. 5. The Web
  6. 6. Big Business/Clever People
  7. 7. Case 1 • • • • • 28 female Known polysubstance abuse Presents agitated, & diaphoretic Vitals: BP 172/89, HR 128, RR 30, Temp 37.9 Given IVIH, IV Diazepam – symptoms settle • Admits to smoking “spice”
  8. 8. Synthetic Canabinoids • “K2” “Spice” – “legal Marijuana” • Typically sold – “incense” “room fresheners” • Labeled - not for human consumption • Sold OTC or Internet - $20-30
  9. 9. Synthetic Canabinoids • Difficult to detect Contains: • Herbs/vegetables sprayed chemicals • Target CB1 receptors in brain Generally smoked – Can be injected (tea), baked (cookies)
  10. 10. The Symptoms • • • • • • Agitation - Psychosis Tachycardia Hypertension Arrhythmia's Metabolic derangements Seizures
  11. 11. ED Management • • • • • Supportive care Give Benzo’s – agitation, anxiety Monitor temp Fluids – dehydration Look for co-ingestions
  12. 12. Case 2 • • • • • 22 male BIB Police Found - agitated, palpitations, paranoid Smoke some “Crystals” Brought it of the net! Vitals: BP 185/96, HR 142, Temp 38.2
  13. 13. Designer Amphetamines • Mephedrone. • “Meow-Meow”, “Bath Salts” • Synthetic derivative – cathinone – Derived leaves Khat plant
  14. 14. Mephedrone Synthetic stimulant: • Euphoric & psychostimulant effects • Similar to MDMA, Cocaine, Methamphet • Illegal in Australia – Easily available over net!
  15. 15. Mephedrone Presents: – Clear white powder – Crystals (bath salts), capsules , pills Taken: – Ingested, injected, smoked Cost: $20-$50 a hit!
  16. 16. Mephedrone • Short half life – 30-90mins • Effects last 2-4 hours • Results in compulsive re-dosing Causes pronounced peripheral vasoconstriction
  17. 17. ED Management • Supportive care – Hydration, bladder care • Give benzo’s - agitation, HR, HT, temp • Monitor Temp >39 risk MOF • Monitor for seizures, hyponatraemia • Caution with antipsychotics
  18. 18. Case 3 • 35 female Presents to ED with 2/52 hx: – Weakness – Thirst – Nausea • Appears dehydrated, generalised weakness in all 4 limbs.
  19. 19. Blood Gas
  20. 20. Her ECG
  21. 21. Further History • Admits to using 4g Nurofen+/day • Addicted to opioids
  22. 22. Nurofen Plus Abuse • • • • • Emerging problem Its all about the codeine Cheap – available OTC Each tablet 200mg nurofen/12.8mg codeine Reports pt’s abusing 60-100 tablets/day
  23. 23. The Issues • Renal tubular acidosis • Metabolic complications: – Hypokalaemia – Hyperchloraemia – Hypophosphataemia • GI Bleeds
  24. 24. Renal Tubular Acidosis Essentially failure of: – H+ excretion or – HCO3 reabsorption Causes: – Chronic renal disease, autoimmune, genetic, – Drugs – lithium, ibuprofen, toluene
  25. 25. ED Management • Treat medical complications • Often require ICU/HDU • Electrolyte replacement – K, Mg • Surgery/scopes - if bleeding • Opioid withdrawal • Excellent supportive care
  26. 26. Remember ‘”Every Turkey has a terminal event”” “Always consider medical causes”
  27. 27. Further Info/Resources
  28. 28. Street Drugs in 2013 • Countless new agents – Cheap & easily available • Generally structurally variants of old • Toxicity somewhat predictable • Management principles largely the same
  29. 29. Questions
  30. 30. Thankyou

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