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Drug misuse and dependence

Drug misuse and dependence. How did we get here?. Recently finished VTS- leeds/bradford Interested in the field, work in a practice with similarly minded doctors. RCGP part 1 and 2 courses. Afternoon outline. What do you want to know

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Drug misuse and dependence

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  1. Drug misuse and dependence

  2. How did we get here? • Recently finished VTS- leeds/bradford • Interested in the field, work in a practice with similarly minded doctors. • RCGP part 1 and 2 courses.

  3. Afternoon outline • What do you want to know • Try to answer some of this and give outline of treatment in drug uses in UK • Coffee break • Some cases to discuss • Expect to be in interrupted

  4. Aims • Increase understanding, awareness and confidence in managing drug misusers • Have framework to help deal with drug users in surgery • Knowledge of where to get help.

  5. What do you want to know?

  6. Some figures • 141000 in treatment 2001/2 • 38% of 15yr olds used a drug in last year • One study of 160 homeless 16-25yr olds 89% in last year (95% ever) • 65% of all arrestees positive for some form of drugs • 1.2% mortality per year in heroin users

  7. Classification of drugs • Class A – cocaine, heroin, methadone, morphine, PCP, ecstacy, LSD. Any injected class B drug • Class B – amphetamine, dihydrocodeine, Ritalin, barbiturates • Class C – cannabis, benzodiazepines

  8. Another language • Gear, brown, smack • Rocks, white, crack • Uppers, downers • Blues and yellows • Skunk?

  9. The Drug Addict • What do you think are the characteristics of a stereotypical drug addict? • Are all drug addicts the same?

  10. Reasons for starting • Peer group pressure • Enjoyment • Self manage mental health illness • Self manage chronic pain • Iatrogenic

  11. Risk factors • Prior delinquent behaviour • Social class • Peer group influences • Risk taking behaviour • Parental • Poor quality of relationships • Inconsistent parenting • Lack of participation in conventional activities eg employment and education

  12. How do you feel??

  13. Primary care role • Assessment • Management • Education • Signposting

  14. Aims of treatment • Accessibility and health improvement • Harm minimisation • Reducing associated deaths • Reducing associated criminal activity • Appropriate treatment and referral • Improve social, personal and family fctn.

  15. Assessment • History – Why now? primary drug, present problems, drug history, physical symptoms, worries and concerns. Children and other family members • Examination – injecting sites, evidence of DVT, general health inc dental. BMI • Discuss options ahead

  16. Presentation of substance misuse in general practice

  17. Local services • Current treatment agencies in Bradford • SMS (Fountains Hall), Ripple, NBPCT DS, Bridge Project, Henry Street, CDAT • GP surgeries inc Kensington St, Farrar MC, Ling House • Could change with new pct?

  18. Management options • Needle exchange • Methadone • Subutex • (dihydrocodeine) • Detox • Daycare • Rehabilitation

  19. Sources of further information • RCGP website • www.smmgp.org.uk • www.scan.uk.net • Drugscope • Loads of possibilities- a lot of independent sites eg urban75

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