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ILLICIT DRUGS. Soap Box Kate Rees Swindon/Bath GP Registrar DRC 12/05/05. Why?. Previous experience at Rockhall Shared-care practice Diploma in Substance Misuse part 1 We can save lives – scary stats to follow…. What and How?. What’s out there, what guise it takes

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illicit drugs

ILLICIT DRUGS

Soap Box

Kate Rees

Swindon/Bath GP Registrar DRC 12/05/05

slide2
Why?
  • Previous experience at Rockhall
  • Shared-care practice
  • Diploma in Substance Misuse part 1
  • We can save lives – scary stats to follow…
what and how
What and How?
  • What’s out there, what guise it takes
  • What should we be doing about substance misuse and misusers
  • And how can we achieve this.
facts
Facts
  • 6-9/1000 adults (15-64) drug problem
    • IVDU
    • On long term opiates, cocaine, amphetamine
    • That’s 25 patients in 1,800 average list
  • 3:1 male/female (girls under-detected)
  • 14 X MORTALITY general population
  • 34 X MORTALITY in prison leavers
  • 30-80% IVDU Hep C positive
  • 1-3% HIV positive
slide6
Cannabis
    • Bhang, black, blast, blow, blunts. Bob Hope, bush, dope, draw, ganja, grass, hash, hashish, hemp, herb, marijuana, pot, puff, Northern Lights, resin, sensi, sensemilla, shit, skunk, smoke, soap, spliff, wacky backy, weed, zero.
    • Hash (blacky-brown lump)= resin of the plant.
    • Grass or weed =dried leaves
    • Price varies
    • Smoked, eaten, drunk, bong, bucket
slide7
Ectasy
    • E, pills, brownies, burgers, disco biscuits, hug drug, 'Mitsubishi's', 'Rolex's', 'Dolphin's', XTC
    • Pills, liquid form (GBH)
slide8
LSD
    • Acid, blotter, cheer, dots, drop, flash, hawk, L, lightening flash, liquid acid, Lucy, micro dot, paper mushrooms, rainbows, smilies, stars, tab, trips, tripper, window.
    • Tiny squares of paper, liquid or pellets
    • Cost £1 - £5 a tab
slide9
Benzodiazepines
    • Jellies, benzos, eggs, norries, rugby balls, vallies, moggies, mazzies, roofies, downers.
    • 10mg diazepam = £1
slide10
Speed
    • Amphetamine Sulphate, Phet, Billy, Whizz, Sulph, Paste, Base Ice, Meth, Dexies, Yaba
    • usually sold as powder wraps like cocaine.
    • Base speed is purer = putty.
    • Crystal meth, or methamphetamine = rocks or crystals.
    • Prescription dexamphetamine = pills.
    • Dabbed, sniffed, swallowed, injected or smoked
slide11
Cocaine
    • coke, charlie, C, white, Percy, snow, toot.
  • Crack
    • rocks, wash, stones, pebbles, base, freebase.
    • smokeable form (lumps)
    • cocaine, baking soda and water.
    • A rock = £12 and £20
  • Speedball
    • Injection mixture cocaine and heroin
slide12
Heroin
    • Brown, skag, H, horse, gear, smack
    • smoked, snorted or injected
    • Purity 20-60%
    • £10 bag= roughly 0.2-0.3g
    • Addicts habit 0.5g- 2g (or teenth) /day
what should we be doing doh drug misuse guidelines
What should we be doing? DoH Drug Misuse Guidelines

 Diagnosis of drug misuse

 Brief assessment

 Harm reduction

 Safer sex advice

 Hepatitis A, B, C and HIV testing

 Hepatitis B immunisation (and A if appropriate)

 Referral to appropriate services

  • for drugs treatment
  • sexual health
  • infectious diseases

 General health care, including nutrition.

how we begin
How we begin….
  • Confidentiality
  • Notification to NDTMS (National drug treatment Monitoring scheme) anonymous
  • Don’t rush into planning substitute medication or withdrawal programme

– it may be more dangerous

  • DVLA considerations
how we assess history
How we assess - History
  • Why have they presented today.
  • Past and current drug use.
    • Types and quantities used; +/- alcohol
    • Routes
    • Experiences of overdose
    • Periods of abstinence and triggers for relapse
    • Cost of drug misuse
    • Symptoms of Withdrawal ‘clucking’
    • Dependence
dependence syndrome
Dependence Syndrome
  • ICD 10 criteria
  • 3+ in last year:
    • Compulsion
    • Difficulty controlling use
    • Physiological withdrawal
    • Tolerance
    • Neglect other interests
    • Persist in use despite harmful effects
slide17
3. History of injecting (risk of infection)
  • Supply of needles
  • Sharing habits
  • How to inject safely
  • How do they dispose of used equipment
  • Knowledge of HIV/HepB/C
  • Use of condoms

4. Medical History

  • Hep B/C and HIV status
  • Last cervical smear
  • LMP
slide18
5. Psychiatric history

6. Forensic history

7. Social history

  • Do they have kids
  • Do they have a place to live
  • Do they have a job/money

8. Past contact with Rx services

examination
Examination
  • Physical
    • Opiate withdrawal (restless, yawning, sweating, retching, dilated pupils, ↑BP)
    • Opiate toxicity (pyrexia, ataxia)
    • Cocaine (vasoconstrictor, local anesthetic)

BP, peak flow

    • Injecting complications – cellulitis/abcess, dvt/pe, liver disease
  • Mental health
    • Psycosis (cannabis, speed, cocaine)
    • Anxiety/Depression
investigations
Investigations
  • Bloods
    • HepB, HepC, HIV
  • Urine
    • on the premises (5-10mls)
    • Non-punitive
    • Confirm diagnosis
    • Helps with treatment plan
    • Covers you medico-legally
    • Protects patient from inappropriate px
    • ↓street diversion
immunisations
Immunisations
  • Hep B
    • Offer immediate vaccination if not already infected/immune
    • Incubation period 6/52 - 6/12.
    • 70% asymptomatic
    • If result positive can discontinue
    • Vaccine recommended for IVDU and contacts esp. partners and children
  • Hep A now also recommended
hep c
Hep C
  • 92% IVDU related – sharing any equipment/ paraphernalia
  • Only 5% STI
  • 80% long term infection/ 20% clearance
  • Routine antibody test detects past or present infection
    • PCR/referral to gastro for treatment (if no iv use or alcohol dependence)
harm reduction
Harm Reduction
  • Route
  • Safe injecting
    • sites, equipment, precipitation, company
  • Avoiding cocktails – O/D risk
  • GUM if prostitution
  • Pregnancy – often amenorrhoea. High risk pregnancy when entering treament.
the end
The End
  • RCGP certificate Part 1
    • www.doctorsnet.uk
    • www.smmgp.org.uk
    • mark@smmgp2.demon.co.uk
  • NEXT course next wed 19th Oct in Yate
    • Neil.Kerfoot@GP-L81063.nhs.uk
    • 01179 611774