This document provides guidelines for responding to acute care needs arising from substance misuse. It outlines physical risks like overdose, accidents, and harm to others that require emergency medical care. Signs of overdose from depressants, stimulants, and hallucinogens are described. Risks include toxicity from polydrug use, accidents due to intoxication, and violence related to alcohol or psychosis from other drugs. Professional standards for responding are discussed along with evidence-based sources to guide care.

1. Evidence-based
guidelines for
responding to acute
care and support needs

2. Evidence-based guidelines for
acute care support
• Welcome to this resource.
• Here we will explore the evidence-based
guidelines for responding to acute effects of
misused substances.
• We will not be examining emergency and
crisis care itself as that is provided in the
resource entitled ‘immediate or crisis action’.

3. Outcomes
Specific outcomes will be to:
• Identify the current guidelines for acute care.
• Outline the range of responses in different settings and areas of
practice.
• Refer to further guidance and update resources.

4. What are acute care needs?
• Our definition here
encompasses the scope of
health and social care practice
contexts.
• However, we will focus on
physical, psychological, and
social needs, in the short term.

5. Physical needs
Acute intoxication can put someone in
danger for many reasons.
Three key ones may be:
1. Risk of overdose/poisoning.
2. Risk of accidents.
3. Risk of harming others.

6. Signs of overdose - depressants
• Signs of overdose from
depressants will include
drowsiness, lethargy, constricted
pupils, slurred speech, reduced
breathing rate.
• These will require emergency
medical treatment and the person
needs to be taken to the accident
and emergency department.
• There, the person will receive
antidote medication to counter the
effects of the overdose.

7. Signs of overdose: stimulants &
hallucinogens
• Signs of intoxication and overdose from stimulants or
hallucinogens will include over-activity, elation,
giggling, raised vital signs, aggression.
• There may also be psychosis (hallucinating, feelings
of persecution, expressing strange ideas).
• These will require hospital treatment due to risk of
cardiovascular accident (stroke, cardiac arrest).
• Psychosis will need medical assessment and
treatment.

8. Toxicity
• Overdose and poly drug use are common forms of poisoning.
• Using too much of a drug or stronger mixtures of it, and using it with
another substance, which enhances its effects, is common.
• People who have overdosed may try to counteract the effects by
using something else on top.
• Excessive drowsiness, over-activity, vomiting or wayward behaviour
are signs of the need for urgent medical attention.

9. Risk of accidents
• Intoxication from a depressant drugs puts the person at risk from a
lack of self protection.
• They are also at risk of vomiting and choking.
• Someone who is drunk or comatose should be placed in the
unconscious position - to avoid inhalation of gastric contents -
and be monitored.
• They are at risk of exposure, postural asphyxiation and dehydration.
• A person should not be left alone if likely to become
unconscious. They need positioning and warmed up/cooled
down. Give fluids if conscious. Hospitalise if unresponsive.

10. Risk of accidents (cont.)
• Intoxication on stimulants or hallucinogens can provoke risk taking
behaviour.
• They may engage in daredevil acts or be unaware of
environmental dangers. They may attempt to go
swimming, walk on railway tracks, run across roads
or even drive.
– As a health or social care professional, you have a duty of care
to a person you know is in acute risk from substance use.
– If you are unable to manage the person’s condition, you need to
contact emergency services to ensure the person is in a place of
safety – this could be a police cell or A & E!

11. Alcohol intoxication: risk to others
• Driving. It is illegal to drive in England with a blood alcohol level above
80mgs/100mls vol. This is not very much and likely to be reduced in line
with Scotland and Europe at 50mgs/100mls vol. in the near future.
• See the case study in this resource for an illustration of professional
responsibility in relation to drink driving.
• It is illegal for someone to be in sole charge of a young child if they are
intoxicated (with alcohol or any other psychoactive drug).
• This puts the child in danger as there is no responsible adult to keep
them safe.
• It is your responsibility to ensure the safety of a minor, or other
vulnerable person, if they are not supervised. See the resource on
Safeguarding for more on this.

12. Alcohol intoxication: risk to others
• Domestic and other violence. Domestic violence
affects the partner and any other member of the
family in the household – as well as the perpetrator.
• You are responsible for the safety of others if you
have clear suspicions of domestic violence.
• See the resource Domestic violence and substance
use for more on this. Also, see the resources for
Supporting family members and Impact on children
and Impact on family carers and parents.

13. Stimulants and hallucinogens: risk
to others
• These substances can cause temporary or enduring psychotic
states. This may include feelings of persecution and hallucinating.
• While many people in this state are more likely to harm themselves,
they can be aggressive towards others.
• Someone exhibiting psychotic symptoms needs psychiatric
assessment and may require control using the Mental Health Act. A
GP or a psychiatrist is normally the person able to section someone
under the Act in order to keep them safe.
• A police officer is also empowered to arrest someone who may be
suffering a mental illness and is a danger to themselves or others.

14. Professional standards
• HCPC (2012) Standards of conduct, performance and ethics.
http://www.hcpc-
uk.org/aboutregistration/standards/standardsofconductperformancea
ndethics/
• NMC (2015) The Code: Professional Standards for Practice and
Behaviour for Nurses and Midwives. Available at:
http://www.nmc.org.uk/globalassets/sitedocuments/nmc-
publications/revised-new-nmc-code.pdf

15. Evidence and sources of
information
• Department of Health (England) and the devolved administrations (2007). Drug Misuse and
Dependence: UK Guidelines on Clinical Management. London: Department of Health
(England), the Scottish Government, Welsh Assembly Government and Northern Ireland
Executive.
• Ghodse A H (2002) Drugs and addictive behaviour: A guide to treatment. 3rd edition.
Blackwell Science. Oxford.
• NICE (2012) Quality Standards for Drug Use Disorders. National Institute for Clinical
Excellence. Quality Standard 23.
• NICE (2010) Alcohol-use disorders: preventing the development of hazardous and harmful
drinking. National Institute for Health and Clinical Evidence, Public Health Guidance 24.
• NICE (2007) Drug Misuse: psychosocial interventions. National Institute for Health and
Clinical Evidence Clinical Guideline 51.
• Rassool G H (1998) Substance Use and Misuse: Nature, Context and Clinical Interventions.
Oxford, Blackwell.
• Rassool G H (2009) Alcohol and Drug Misuse: A Handbook for Students and Health
Professionals. Oxford, Blackwell.
• Parsons G (2015) Illicit drug overdose: managing emergency care. The Pharmaceutical
Journal. Available at: http://www.pharmaceutical-journal.com/learning/cpd-article/illicit-drug-
overdose-managing-emergency-care/20068355.cpdarticle