1. Introduction to Drug Misuse Les Goldman

2. Objectives Gain basic knowledge of Common current patterns of drug misuse Local referral pathways Available treatments Gain basic knowledge of Common current patterns of drug misuse Local referral pathways Available treatments

3. Commonly misused drugs Cannabis - draw weed Ecstasy, LSD Solvents Amphetamines - whizz Opiates - gear brown Cocaine - crack rock stone Benzodiazepines - blues Cannabis - draw weed Ecstasy, LSD Solvents Amphetamines - whizz Opiates - gear brown Cocaine - crack rock stone Benzodiazepines - blues

4. Common patterns of drug misuse Primary heroin IV or inhaled plus Methadone, DHC etc when supplies low Benzodiazepines for depression Cocaine occasionally as treat Cannabis daily Primary cocaine use - intense binges plus Heroin and/or benzos afterwards Cannabis Primary heroin IV or inhaled plus Methadone, DHC etc when supplies low Benzodiazepines for depression Cocaine occasionally as treat Cannabis daily Primary cocaine use - intense binges plus Heroin and/or benzos afterwards Cannabis

5. Harmful effects result from Properties of drug Hallucinogen - ecstasy, LSD Depressant - opiates, benzodiazepines Stimulant - amphetamine, cocaine Addictive potential Mode of administration Oral - overdose risk Smoked / inhaled - heat, tobacco, ash, toxic fumes Injected - overdose and infection risk, arterial injury, DVT Use in combination With other drugs With alcohol Properties of drug Hallucinogen - ecstasy, LSD Depressant - opiates, benzodiazepines Stimulant - amphetamine, cocaine Addictive potential Mode of administration Oral - overdose risk Smoked / inhaled - heat, tobacco, ash, toxic fumes Injected - overdose and infection risk, arterial injury, DVT Use in combination With other drugs With alcohol

6. Primary Care interventions - assessment 1 5 areas Drug use (which drugs, quantity used, duration of use, mode of administration, experience of withdrawal and overdose, previous treatment) Physical health Psychological health Social circumstances (friends, family support, housing, work) Involvement with criminal justice system 5 areas Drug use (which drugs, quantity used, duration of use, mode of administration, experience of withdrawal and overdose, previous treatment) Physical health Psychological health Social circumstances (friends, family support, housing, work) Involvement with criminal justice system

7. Primary Care interventions - assessment 2 Objective confirmation History Examination Investigation Objective confirmation History Examination Investigation

8. Primary Care interventions - motivation Cycle of change - something to offer at each stage Precontemplation Contemplation Action Maintenance Relapse Cycle of change - something to offer at each stage Precontemplation Contemplation Action Maintenance Relapse

9. Primary Care interventions - harm reduction Accurate information about drug effects and risks Verbal Written Encourage safer pattern of use Care with combinations of drugs / alcohol Smoke rather than inject Safer smoking / injecting techniques Manage physical health problems Preventive health care Overdose prevention (dont inject alone, learn basic CPR) Vaccination (hep A, hep B, tetanus) Accurate information about drug effects and risks Verbal Written Encourage safer pattern of use Care with combinations of drugs / alcohol Smoke rather than inject Safer smoking / injecting techniques Manage physical health problems Preventive health care Overdose prevention (dont inject alone, learn basic CPR) Vaccination (hep A, hep B, tetanus)

10. Appropriate referral 1 Bridge Project (non-statutory) Counselling, harm reduction, needle exchange Activities (music, IT, gym, complementary therapies) Treatment Womens Service Young Peoples Service Stimulant Service Bridge Project (non-statutory) Counselling, harm reduction, needle exchange Activities (music, IT, gym, complementary therapies) Treatment Womens Service Young Peoples Service Stimulant Service

11. Appropriate referral 2 PCT level primary care based services NBPCT Drug Service Ripple Project City SMS Personnel - GPwSI, CPN, physical health nurse, drugs worker, vocational advice, social support, carer support, community development Principally opiate dependence services Main exclusions Complex poly - substance misuse Serious mental health problems Young people PCT level primary care based services NBPCT Drug Service Ripple Project City SMS Personnel - GPwSI, CPN, physical health nurse, drugs worker, vocational advice, social support, carer support, community development Principally opiate dependence services Main exclusions Complex poly - substance misuse Serious mental health problems Young people

12. Appropriate referral 3 Specialist Services CDAT (Horton Park Centre) One Stop Maternity Service Young Peoples Service Day Care Detoxification programmes Other services Carers Self help (Narcotics Anonymous) Specialist Services CDAT (Horton Park Centre) One Stop Maternity Service Young Peoples Service Day Care Detoxification programmes Other services Carers Self help (Narcotics Anonymous)

13. Criminal Justice and Drugs Drug Intervention Programme (DIP) Restriction on Bail (ROB) Drug Treatment & Testing Order (DTTO) Support workers Structured activities Drug Intervention Programme (DIP) Restriction on Bail (ROB) Drug Treatment & Testing Order (DTTO) Support workers Structured activities

14. Principles of treatment 1 choice of intervention Substitute prescribing Appropriate for e.g. opiate and benzodiazepine misuse Harm reduction Physical Psychological Social Maintenance / detoxification Symptomatic relief Appropriate for e.g. cocaine misuse Relapse prevention Medical - naltrexone Non medical - supportive counselling Substitute prescribing Appropriate for e.g. opiate and benzodiazepine misuse Harm reduction Physical Psychological Social Maintenance / detoxification Symptomatic relief Appropriate for e.g. cocaine misuse Relapse prevention Medical - naltrexone Non medical - supportive counselling

15. Principles of treatment 2 choice of opiate substitute Methadone Long acting Cant inject mixture Sedating Withdrawal sometimes difficult Buprenorphine (Subutex) Long acting Blocking effect (safer but risk of precipitate withdrawal on starting treatment) Less sedating Easier withdrawal Dihydrocodeine Easily diverted Easier withdrawal, useful for quick detox Less potent Methadone Long acting Cant inject mixture Sedating Withdrawal sometimes difficult Buprenorphine (Subutex) Long acting Blocking effect (safer but risk of precipitate withdrawal on starting treatment) Less sedating Easier withdrawal Dihydrocodeine Easily diverted Easier withdrawal, useful for quick detox Less potent

16. More information Drug Misuse and Dependence - Guidelines on Clinical Management DoH 1999 www.smmgp.co.uk Guidelines and info www.drugscope.org.uk Easy to use source of information www.nta.nhs.uk DoH agency commissioning drug misuse services Drug Misuse and Dependence - Guidelines on Clinical Management DoH 1999 www.smmgp.co.uk Guidelines and info www.drugscope.org.uk Easy to use source of information www.nta.nhs.uk DoH agency commissioning drug misuse services