Harm Minimisation PDF

Harm minimisation Alcohol & Other Drug (AOD) use - Most AOD use is experimental or recreational. - Most AOD use can be considered functional. - The period of illicit drug use for most people is relatively short. - Only a minority develop dependence. Harm minimisation - H...

Harm minimisation Alcohol & Other Drug (AOD) use - Most AOD use is experimental or recreational. - Most AOD use can be considered functional. - The period of illicit drug use for most people is relatively short. - Only a minority develop dependence. Harm minimisation - Harm minimisation has been a key policy of Australian state and federal government since the 1985 launch of the national campaign against drug abuse and the subsequent national drug strategy. - à National Drug Strategy. Harm minimisation - Supply reduction à usually relate to enforcement. o Customs, importations seizures, law enforcement. - Harm reduction o Reduce desirability of heroin by providing better alternatives (methadoneà long-acting opioid, can save dependent on heroin) - Demand reduction (lessening the harm of people who are dependent.) o Needle exchange, supervised injecting centres, information of safer injecting. The harm minimisation approach is based on: - Drug use, both illicit, is an inevitable part of society. - Drug use occurs across a continuum, ranging from occasional use to dependent use. - A range of harms are associated to diOerent types and patterns of alcohol and other drug (AOD) use. - A range of approaches can be used to respond to these harms. Evaluation of the National Ice Action Strategy - Aims: prevent use of methamphetamine (ice) and other drugs. - Help those who are using these drugs to stop. - Reduce the harms that drugs cause to people and communities. - Ice dependent people à harmful to other people as well not just themselves. Role of the pharmacist - Understanding intoxication and withdrawal states of other drugs. - Ability to refer. - Education - Empathy - Support – demand reduction - Non-judgemental advice. Needle syringe program - Aim: To reduce the harm associated with drug use to the drug user themselves as well as the community. - Reduce risk – provide education – provide referral – point of contact. - Strong evidence – they do not increase injecting drug use. - If the patient brings four syringes and want five syringes à we just give them five and kindly ask them where’s the other one. We explain the reason à communicate. Alcohol misuse - External and internal implications. - Pharmacotherapies available o Acamprosate. o Naltrexone o Disulfiram o Topiramate? National drug strategy - Use of pharmaceuticals for non-medical purposes increased. - OTC painkillers are no longer S3 à shifted to S4 - The most commonly misused pharmaceuticals were painkillers/opiates. Factors aHected drug dependence - Drug o Pharmacological eOect, onset of action, duration of action, route of administration, purity, availability, cost. - User o (impulsiveness, risk-taking, sensation seeking), psychosocial (poor coping skills, low self-esteem, history of psychological trauma), psychiatric co-morbidity (anxiety, depression, psychosis). - Environment o Family, peers, social. CNS DEPRESSANTS (DOWNERS) - Sedative-hypnotics o Benzodiazepines o Barbiturates - Narcotic analgesics o Opioids - General anaesthetics o Nitrous oxide, gamma-hydroxybutyrate (GHB,GBH,fantasy) - Cannabis - Alcohol CNS stimulants (uppers) - Nicotine - CaOeine - Cocaine - The amphetamines Dependence - 3 occurring at any time in the same 12-month period. o Strong desire to use. o DiOiculties controlling use. o Persistent use despite harm. o Higher priority given to drug use than to other activities/obligations. o Increased tolerance. o Physical withdrawal. Dependence syndrome - Tolerance (with time more is needed to reach same feeling) - Withdrawal - Use to reduce withdrawal - Compulsion to use (especially when trying to reduce or stop) - Narrowing repertoire of behaviour. - Drug related behaviour takes precedence. - Early relapse after withdrawal. - Chronic relapsing disorder. Aetiological factors - Multi-factorial - Dysfunctional family background - Physical/sexual/emotional abuse - Stressful life events - Mental health Mental health of young people aged 16-24 - Young people with a mental health disorder are more than 5x as likely to use illicit drugs or misuse legal drugs. Comorbidity à why with mental health? - The presence of a mental health condition may lead to AOD use à self-medication hypothesis. - The AOD intoxication or withdrawal may induce a mental health condition. Harm minimisation – demand reduction (treatment) - Drug dependence is a chronic relapsing disorder which needs to be seen in a medical, behavioural and social context. - Treatment is to promote rehabilitation and improve functioning. - Need to work with the patients and their aspirations rather than try to control their behaviour. - Requires establishing a therapeutic, non-judgemental relationship. Treatment - Example) à refer to the methadone clinic. - What is opioid substitution treatment (OST)? o Daily dose of longer-acting opioid agonist § Methadone § Buprenorphine § Buprenorphine/naloxone o Supervised daily dosing at a dosing site. § Public drug & alcohol clinic. § Community pharmacy § Private clinic § Prison o Most cost-eOective treatment for opioid-dependent people § Most of them don’t pay à only pay dispensing cost. o Need to check if they have swallowed by talking etc. Barriers to treatment - Patients with substance misuse may have: o Poor family/social support o Poor nutrition and living circumstances. o Encountered real or perceived prejudice by health care staO. - DiHiculties with adherence: o Preoccupation with substance misuse. o Disorganisation/intoxication. o Limited finances/unemployment.