drug awareness

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

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.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