9 - Drug misuse in medical patients

Summary

Introduction

There has been an increasing interest in and awareness of drug problems in the UK over the last decade. This has been reflected in a raft of policy initiatives which include:

• Purchasing Effective Treatment and Care for Drug Misusers (1996)

• Clinical Guidelines on the Management of Drug Misuse and Dependence (1999)

• Substance Misuse Detainees in Police Custody (2000)

• Safer Services (1999)

• Safety First (2001)

• Tackling Drugs to Build a Better Britain (1998)

• National Drugs Strategy (1999, 2000, 2001)

• Recommendations from the British Association of Psychopharmacology (2004).

Substance problems may present in a variety of different medical settings in both primary care and secondary care. Indeed, no speciality is exempt from drug misusers presenting; accident and emergency, paediatrics, geriatrics, cardiology, dermatology, neurology, gastroenterology, infectious disease, obstetrics, neonatology, trauma and orthopaedic surgery, and general surgery will all be seeing patients who are using, misusing or are dependent on drugs. All psychiatric specialities, including liaison psychiatry, will have their fair share; in particular those dealing with general psychiatry, child and adolescent psychiatry, old age psychiatry, forensic psychiatry, learning disability, and eating disorders, will be assessing and treating patients with substance problems. Thus, the liaison psychiatrist will undoubtedly come across patients with drug problems.

For the purposes of this chapter, we will concentrate on illicit drugs and the misuse of prescribed medication. Thus, we include central nervous system depressants, e.g. benzodiazepines, solvents and gases, opiates and opioids, drugs that alter perception, e.g. LSD (lysergic acid diethylamide), hallucinogenic mushrooms, cannabis, khat, central nervous stimulants, e.g. amphetamines, cocaine, and ecstasy.