Treatment of dependence on non-opiate substances

What are the intended treatment outcomes for non opiate drugs?

• Reduce drug related crime, protect public

• Reduce BBV transmission, protect pubic

• Improve physical health

• Improve mental health

• Improve social functioning e.g. relationships, families and meaningful occupation

What is principle of replacement therapy?

to protect from toxic drug supply,

reduce drug related crime and criminality holds for other addictions

but the risk:benefit ratio may not be the same.

What are the mainstay of treatment for cocaine, cannabis, amphetamine and ketamine dependence?

Non pharmacological therapies

When can relapse prevention therapies be useful?

in highly motivated individuals.

What is the pharmacological detoxification for alcohol?

Use benzodiazepines; diazepam
for EtOH dependence often chlordiazepoxide

How does benzo detoxification work?

• Planned, agreed short course reduction for alcohol.

• Maintenance risks with diazepam daily long term

• Needs balance as increase mortality with benzos and opioids

What risk needs to be assess for alcohol detoxification?

Risk in community → for seizures may do in hospital

What are the adverse effects of disulfiram?

intense flushing, dyspnoea, headache, palpitations, tachycardia, hypotension, nausea and vomiting
Patients should carry a card

What is Acamprosate?

may stimulate GABAergic inhibitory neurotransmission & antagonise excitatory amino-acids e.g. glutamate, to reduce craving of alcohol

Naltrexone in alcohol?

a specific, high affinity, long acting competitive antagonist at opioid receptors, blocks on top opiate use, also benefit shown in alcohol

What are some features of stimulant dependence?

• Psychological & some physical dependence

• Binge patterns of use, with or without daily chronic use

• Risks to CV system, mental health, physical risks from administration (nasal, IV, smoked etc)

• Associated mental health risks

• May be primary drug used or secondary/poly drug use.

Cannabis?

susceptible individuals can have real dependence issues and linked with psychosis, depression and other psychiatric problems

What adjunct prescribing may happen

• Complications e.g. insomnia–need to remove the cause in an ideal world

• Short term BZ or Z drugs used – restrict to max 14 days

• Antidepressants.

• Be alert to co-existing mental health problems

Examples of adjuncts in opiate detox

loperamine, hyoscine, short term BZ / Z drug.

Psychosocial interventions

CBT
Motivation interviewing
Assistance with housing and food
Social activities
Employment
Sustainable outcomes
Self help mutual aid

contingency management and family and couples intervention

What is an highly important factor of psychosocial care

The relationships that the individual has with those involved in care provision have been shown to be highly important in determining the outcome of treatment.

How can pharmacy provide psychosocial support?

discuss goals with individuals and offer positive praise.
Encourage engagement with structured psychosocial support
Signpost to support services
what is available e.g. local food banks
Discuss with people at the end of a detox if they have psychosocial support