Drug and Alcohol Misuse

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Drug and Alcohol Misuse

• Dr Mick McKernan

2
Harm Reduction

• Philosophy to lessen the dangers drug abuse cause
  to Individual/society
• We will never stop drug misuse 15K BC cannabis.
  Opiates 5K B C. Alcohol 10k BC
• Holistic care. Crime/criminal behaviour/employment
  /mental health /physical health/family
  therapy/alternate medicine/ 3rd sector
  /housing/finance

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Maintenance DetoxificationAbstinence

• Client agenda detoxification
• Service agenda -maintenance
• Political Pressure to push for detoxification and
  abstinence

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Families and Communities

• Hidden Harm report gave estimate of 300.000
  children living with problem drug users
• More proactive on children's issues-not waiting
  until risk
• Children ending up cared for-very high-50
• Attracting women into treatment

5
Blood Borne Viruses

• Current levels of morbidity and mortality are of
  concern. Future outcome and costing to NHS is
  unknown but expected to rise. ?400,000 Hep C
  positive. 50,000 known cases. 7,000 treated.
• 44 Hepatitis C prevalence amongst IDU represent
  90 of total cases in UK (HPA)
• World prevalence of Hepatitis C is x4 times that
  of HIV
• 2 HIV prevalence- level rising
• Dry spot testing

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Socioeconomic Cost

• 13 billion on crime annual
• 1 million per life time of each user 1 billion
  in Salford alone for current users
• drug treatment s are cost effective-3 saved for
  every 1 spent-mainly through less crime costs
• 40k average crime per annum

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Tobacco

• gt 95 smoking prevalence of those in treatment
• 50 all smokers will die as a result of their
  addiction gt 100k per annum
• NRT/Oral agents
• Evidence suggests tackling nicotine dependence
  improves drug treatment outcomes
• Smoking cessation therapy/advice most cost
  effective NHS intervention

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Alcohol

• NTORS report at yr 1 and 5-no fall in level of
  alcohol misuse
• Annual deaths alcohol 30,000 v 2500 drugs
• Integration of drug and alcohol teams
• Treatment Outcome Profiles- alcohol recording
  and as primary drug from 2007
• Drug trends- polydrug v polydrug and alcohol at
  present

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Alcohol

• 1million dependent drinkers- 60,000 have had
  formal help
• Lack of resources/funding
• Government push to help in this area
• Home/residential detox
• Screening FAST/CAGE
• Brief interventions

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Opiates-Methadone

• A potent opiate 1 cocodamol 0.5ml methadone
  1mg/1ml
• Usual max start 40mg
• Golden rule start low go slow
• Therapeutic range 60-120ml
• Usual max increase 20ml per week
• Caution with alcohol /benzodiazepeines

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Opiates-Buprenorphine

• Very safe
• Partial agonist/full antagonist
• 4-8mg start then 12-24mg daily
• Misuse/diversion
• Cost
• Not for everyone

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Opiates- Injectables

• Little evidence base- need UK research
• Injecting behaviour strongly linked to BBV
  transmission
• Linked to Overdose
• Use is variable by drug teams
• Attracting hard to reach users?
• Only 3 of clients are given injectables
• Expensive 10k per annum per user

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Stimulants

• Services often dominated by opiates and script
  based philosophy
• Lack of evidence for replacement therapies
• Psychosocial interventions
• Stigma of attending an opiate based service
• Role for Contingency management

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Benzodiazepines and Z Drugs

• All work the same way-hypnotics, anxiolytics,
  anticonvulsants, muscle relaxants and amnesics
• All are addictive
• Licensed for 2-4 weeks only
• 1993 10million scripts- 2007 10million scripts
  issued gt Z use

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Drug Users Benzos

• 90 in 1 year period
• linked to higher BBV risk, greater poly-drug use,
  psychopathology and social dysfunction
• Prefer diazepam 10mg (blues)
• Usually orally rarely injected

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Drug Users Benzos

• Used for anxiety, insomnia, Iatrogenic
  dependence, enjoy effects, enhance opiate effect,
  help mood, coping skills, and/or reduce voices
• To help come down from amphetamines, ecstacy,
  crack and cocaine

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Benzo Detoxification

• Fits are very rare at doses below 30mg
• Convert all benzos/z drugs to diazepam e.g.
  Temazepam 20mg diazepam 10mg
• Prescribe in 2mg tablets weekly at most
• Reduce by 2mg every 2 weeks e.g. Diazepam 10mga
  10 week detox