Benzodiazepines and risk behaviour. Graham Mackintosh Critical Incidents Training Officer Scottish Drugs Forum. Overdose: Definition. “Use of any drug(s) in such quantities that acute adverse physical or mental effects occur. It can be deliberate or accidental; lethal or non lethal”.
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Benzodiazepines and risk behaviour Graham Mackintosh Critical Incidents Training Officer Scottish Drugs Forum
Overdose: Definition “Use of any drug(s) in such quantities that acute adverse physical or mental effects occur. It can be deliberate or accidental; lethal or non lethal”.
Linking benzodiazepines and overdose • Reducing drug related deaths, ACMD, 2000 • National Investigation into Drug Related Deaths in Scotland, 2003. • Benzodiazepines and cocaine as risk factors in fatal opiod overdose,NTA 2007. • Clinical Guidelines Drug Misuse and Dependence, draft 2007 • Know the score campaign materials.
Physical effects • CNS depressant • Potential to increase respiratory depressant effects of heroin, other opiates. • Low doses > reduce anxiety Higher doses > sedative effects increase. • Decrease level of consciousness
Behavioural Effects • Perception of risk • Recklessness/ risk taking behaviour • Amnesia • Reduction of fear • Invisible • Invincible • Increased suggestibility
User characteristics? • Higher levels of depression • Higher levels of anxiety • Traumatic life events • Poorer social functioning • Poorer coping strategies Maybe seeking oblivion Para-suicidal behaviour
National Investigation 2003 • Of 171 benzo positive at post mortem only 31% were in receipt of prescription. • This suggests illicit manufacture and/or diversion of prescribed drugs. • Issue for policy makers, service providers, police.
Police seizures • Legal diazepam accounts for vast majority of seizures. • Diversion from legitimate markets. • Unlicensed versions illicitly made or legitimately made abroad but quality does not meet UK standards. • Fakes- many originate from India, Pakistan, Thailand.
“Street valium”? • Nitrazepam, alprazolam • Strong antihistamines – Piriton, Promethazine. Sedative action, side effects drowsiness, dizziness, confusion. • Methenamine – antiseptic/antibacterial can cause irritation of stomach or bladder • Warfarin – blood thinning medication • Amitriptylene - seizures, heart rate,sedation
Unusual reactions • Paradoxical reactions • Increased excitement • Increased anxiety • Hyperactivity • Sexual disinhibition • Hostility • Rage
Who is at risk? • Under 18 • Over 65 • Neurological disorders • Antisocial personality disorder • Learning disabilities • Impulse control problems • Mood – history of aggression • Environment • High doses – high potency • Alcohol
Why? • Anxiolytic / amnesic effects leads to loss of restraint of social behaviour • Reduces ability to concentrate on external social cues • Impaired ability to identify angry facial expression > fail to modify behaviour • Aggressive response to mild provocation more likely • Dissociation between feelings and behaviour – felt more tolerant and friendly but in fact more aggresive
Finally…………… • Hepatitis C • Injecting behaviours • Stimulant users • Dependence • Withdrawal • Seizures • Internet