OSPAP Programme: Substance Misuse Insights

OSPAP Programme: Substance Misuse and Harm Reduction

• Substance misuse encompasses both individual and societal harm.
• Key learning outcomes include understanding the types of misused substances, the role of pharmacies in harm reduction, and the issues associated with harm reduction services.

Scale of the Problem (ONS, Dec 2023)

• In 2022/23, 9.5% (approximately 3.1 million) of 16-59-year-olds reported using an illicit drug in the past year.
• Cannabis is the most commonly used illicit drug, followed by powdered cocaine.
• Nitrous oxide use has decreased significantly since 2020.
• Highest rates of substance misuse were amongst 16-24-year-olds (17.6%), though this has decreased since 2020.
• People from lower-income households are more likely to misuse drugs than those from higher-income households, but age is also a factor, as younger people are more prone to have lower income.

Scale of the Problem (NHS Digital)

• Hospital admissions for poisoning by narcotics and hallucinogens increased to 13,427 in 2022/23, up from 12,226 the previous year.
• Admissions were more prevalent in the most deprived areas compared to less deprived areas.

Admissions for Drug-Related Mental and Behavioural Disorders

• Data (2021-NHS England Digital) shows admission rates per 100,000 population for drug-related mental and behavioural disorders and poisoning by drug misuse, broken down by local authority areas and over time.
• Sunderland's data and comparisons are provided in the presentation's data visualization format.

Substances Which Can Be Misused

• Over-the-counter (OTC) medicines
• Prescription medications
• Volatile substances (e.g., solvents, glues, nail varnish, butane gas refills)
• Plant material (e.g., cannabis, opioids, mushrooms)
• Cocaine
• Caffeine
• Tobacco
• Alcohol

Crystal Meth (Methamphetamine)

• Legislation restricts the amount of pseudoephedrine that can be sold.
• Sales must be conducted only by pharmacists or trained staff.
• Sales should be refused if there's suspicion of misuse.
• Refer to MEP and RPS guides for further details.

Prescription Medicines

• Amphetamines
• Analgesics (including opioids and pregabalin)
• Benzodiazepines
• Hypnotics
• Antidepressants
• Antimuscarinic drugs (e.g., procyclidine)
• Drugs in sport (e.g., anabolic steroids)

Amfetamines (Schedule 2 CD POM)

• Often used to treat narcolepsy and ADHD (e.g., atomoxetine, dexamfetamine, methylphenidate).
• Other uses are limited and should not be used to treat depression, obesity, or for fatigue relief.
• Can be smoked, snorted, taken orally, or injected. (e.g., crystal meth, methamphetamine ice).
• Methamphetamine (ice, crystal meth) is often smoked, snorted, or injected.
• Methylenedioxymethamphetamine (MDMA, or 'ecstasy’) is typically taken orally.
• All have effects similar to cocaine.

Benzodiazepines (Schedule 4, part 1)

• Frequently used as hypnotics (e.g., nitrazepam) or anxiolytics (e.g., lorazepam), but can cause dependence and tolerance.

Volatile Substances

• Methylated spirit ("denatured ethanol")
• Methanol
• Products containing solvents (glues, nail varnish, butane gas refills).
• Inhalation can cause cardiac arrhythmias.
• In 2009, 34 of 46 fatalities from solvent abuse in England were from inhalation. Mothball components like p-DCB and naphthalene.

Cocaine

• Used as a local anesthetic, primarily inhaled nasally (“snorting”).
• An alkaloid base (“crack”) form is more stable and often smoked or heated for inhalation.
• “Crack” is often considered more addictive than hydrochloride forms.
• Causes massive catecholamine release but repeated use can deplete these transmitters.
• Prolonged use can damage nasal tissues.

Misuse of Cannabis Products

• Cannabis is a Schedule 1 controlled drug.
• Contains cannabinoids THC is the most common and causes hallucinations.
• Magic mushrooms also cause hallucinations, as well as other, similar effects.
• No known therapeutic uses.

Drugs of Abuse: Opioids

• Derived from the opium poppy ([Papaver somniferum]).
• Opium contains various alkaloids like morphine, codeine, papaverine, and noscapine.

Heroin

• Also known as diamorphine or diacetylmorphine.
• A semi-synthetic derivative of opium alkaloids, not found naturally in the poppy.
• Used in palliative care for its strong analgesic properties.
• Twice as potent as morphine.
• Schedule 2 controlled drug. (CD POM)
• Often mixed with other substances and injected.
• Oral, smoking, or injection routes are involved.

Harm Reduction Strategies

• Accepted that misuse will not be eliminated totally
• Aims to mitigate the immediate harms of drug misuse.
• Principles include: Accepting misuse but not approving of it; treating users as normal humans; and reducing harm without necessarily eliminating drug misuse altogether.

Substitution Therapy (CKS, 2024)

• Methadone and buprenorphine are frequently used for this purpose in conjunction with psychosocial support.
• Programs may focus on detoxification or maintenance.
• Comprehensive history taking is crucial to assess current drug use, alongside toxicology screening.
• Prescribing is tailored to individual needs.
• Therapy often involves supervised daily administration for several months, initially at least 3 months.

Methadone (CKS, 2024)

• A long-acting synthetic opioid agonist.
• Blocks withdrawal symptoms for 24 hours.
• Provides stable plasma concentrations.

Buprenorphine (CKS, 2022)

• A semi-synthetic opioid partial agonist.
• Less likely to cause respiratory depression.
• Effective at doses above 8mg by blocking other opioid additional binding.

Needle Exchange Schemes

• Reduces risk of disease transmission (e.g., HIV, Hepatitis C).
• Provides access to sterile injecting equipment to drug users.
• Facilitates safety and reduces risk of contamination and overdose.

Supply of Paraphernalia to Drug Misusers

• Legally permitted suppliers include practitioners, pharmacists, authorized drug treatment centers, and substance abuse counselors.
• Pharmacists can provide necessary supplies such as swabs, citric/ascorbic acid, filters, and cookers.

Harm Reduction: Advantages and Disadvantages

• Advantages:

  • Reduced drug-related crime.
  • Reduces harm at individual and societal level.
  • Optimized opportunities for health promotion.
  • Reduced risk of litter

• Disadvantages:

  • High cost.
  • Difficulty achieving abstinence.
  • Potential diversion of treatment.
  • Risks to staff.
  • Concerns over non-return of needles.

From Harm to Help: A 10-Year Drugs Plan (April 2022)

• Government initiative.
• Aims to cut crime and save lives.
• 10-year plan, investing £780 million over 3 years.
• Treatment for addiction as a chronic condition.
• Rebuild substance misuse service, prioritizing better integration.

Pharmacy Services

• Supervised drug administration.
• Needle exchange schemes
• HIV and Syphilis Point of Care Testing
• Health promotion through leaflets.

References

• Specific resources like FRANK, Community Pharmacy England, and Office for National Statistics are listed and accessed on a particular date.

Explore the critical issues surrounding substance misuse and harm reduction in this OSPAP Programme quiz. Understand the statistics, trends, and the role of healthcare providers in addressing substance misuse among different demographics. Learn how young and lower-income individuals are particularly affected by these issues.