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 Restlessness Irritible Craving Yawning Sweating Eyes & nose streaming Sneezing Nausea Abdominal cramps Diarrhoea Backaches Goose flesh

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 oilTCH 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?

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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