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Drug and Alcohol Misuse

Drug and Alcohol Misuse. Dr Mick McKernan. 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

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Drug and Alcohol Misuse

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  1. 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

  3. Maintenance DetoxificationAbstinence • Client agenda – detoxification • Service agenda -maintenance • Political Pressure to push for detoxification and abstinence

  4. 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

  6. 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

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

  8. 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

  9. 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

  10. 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

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

  12. 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

  13. 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

  14. 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 > Z use

  15. 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

  16. 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

  17. 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 10mg=a 10 week detox

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