Polydrug Use
Polydrug Use
Polydrug Use
Polydrug Use Defined
Polydrug use refers to:
“...the concurrent use of multiple drugs, or the combining of drugs. It can occur in a range of patterns and for a variety of reasons, and may or may not involve drug dependence.”
Swan & Ritter (2001, p. 1)
Polydrug Use
Polydrug Use• Becomes a concern in terms of its relative risk
• Generally associated with hazardous or harmful use of > 1 drug
• Appears to be ‘the norm’ amongst many drug-using groups
– many of whom rarely limit use to one drug, or
– who use a primary drug along with a range of other drugs
• Is highly prevalent among clients of drug treatment services.
Polydrug Use
Patterns of Polydrug Use
Think about: context, patterns of use and dependence
Common patterns of use include:
– using from multiple drug classes, but there is no evidence of dependence on any one class of drug
– dependence on one drug class, but use of other drugs
– dependence on several drugs or classes of drugs.
Polydrug Use
The Nature of Polydrug Use
Polydrug use depends on a range of factors:
– demographic and social
– availability and price
– desired effect and outcome of use
– previous experiences (institutionalisation or previous medical treatment appears to influence polydrug use behaviours).
Polydrug Use
Reasons for Polydrug Use
• To enhance effects of other drugs
• To counteract effects of other drugs
• To provide a substitute for a preferred but unavailable drug
• To conform to normative ways of using drugs
• To counteract the unpleasant effects of drugs from different classes
• To self-manage the withdrawal from one drug by using another.
Polydrug Use
Common Drug Interactions (1)
Drug combo Degree ofinteraction
Effects
BZDs + alcohol +++ sedation, intoxication, risk of OD
BZDs + opioids +++ sedation, intoxication, impairment,risk of ODcommon in MMT and elderly
Cannabis +stimulants
+++ offsets cannabis sedation, pulsegreater than either drug alone
Cannabis + alcohol ++ intoxication and impairment
Polydrug Use
Common Drug Interactions (2)
Drug combo Degree ofinteraction
Effects
Opioids +prescribed drugs
- to +++ various meds interact, precautionsneeded for those which respiratorydepression or sedation
Opioids +antihistamines
+++ intoxication, sedation andimpairment
Opioids +stimulants
++ intoxication sedation
Polydrug Use
Harms from Polydrug UseIntoxication, Regular Excessive Use and Dependence
Intoxicationaccidents
overdose and poisoninghangovers
absenteeismhigh-risk behaviour
Regular Excessive Usehealth
financesrelationships
work
Dependenceimpaired control, drug centred behaviour
severe social or psychological problems, withdrawal
I R
D
Polydrug Use
Service Provision and Polydrug Use
• Engage into treatment
• Ensure effective collaboration
• Use Harm Reduction strategies
– prevention BBV, reduce use, crisis intervention
• Multimodal treatment and cross referral
• Regular review.
Polydrug Use
Polydrug Assessment Issues (1)
• Conduct a systematic assessment of each drug class
– episodic use, time frame of at least 4 weeks, changing patterns of use with changing availability, dependence (>1 drug?). Include tobacco !
• Examine relationship between use of various drugs
– Is use of one drug related to the absence or use of another? Any drug free periods? Use of one drug to modify withdrawal from another?
• Identify drug use patterns, dependence and high-risk using practices
– use of drugs from different classes +/- dependence on one or all.
Polydrug Use
Polydrug Assessment Issues (2)
Try to gain a sense of:
• patient’s reasons for choosing to use particular drugs
• their multiple problems or concerns
• how their drug use and lifestyle affects them (include both positive and negative aspects)
• potential for withdrawal.
Polydrug Use
Screening• WHO is developing a composite polydrug
screening instrument:
ASSIST: Alcohol, Smoking & Substance Involvement Screening Tool
• To be used in primary health care settings to help GPs decide whether the patient will benefit most from:
– information
– brief intervention, or
– referral to specialised treatment.
Polydrug Use
Other Assessment Issues• Allow adequate time (more time is needed
than for a single drug assessment)
• Obtain corroborating information
– e.g., friends / family, with consent
• Delay assessment if intoxicated – apply harm reduction principles
• Consider your role and the practice staff in the management of people with complex polydrug use issues.
Polydrug Use
Key Issues in Treatment
• Harm mimimisation strategies a priority
• Opportunistic brief interventions are often all that can be delivered
• Long-term treatment perspective is required – few people abandon all drug use in the short term
• Numbers of drugs used tend to with age
• Patients may only be interested in dealing with most immediate/problematic issues.
Polydrug Use
GPs and Management (1)
• Polydrug issues are complex, patients often present in crisis. Clarify your role
• Consider a ‘shared care’ approach:
– AOD specialists (including mental health services)
– relevant local health and welfare agencies
– crisis intervention services
– families and other peer support groups (esp. useful with young people).
Polydrug Use
GPs and Management (2)
• Develop ongoing therapeutic relationship (BI, counselling etc.); encourage return despite possible frequent non-attendance
• With patient, identify which (most harmful) drug to tackle first for stabilisation or withdrawal
• Polydrug withdrawal is complex – work with (or refer to) specialists
• Ensure contact and liaison with other AOD services.
Polydrug Use
Who is Suitable for Counselling?
• Counselling is suitable for those who:
– self-identify as polydrug users
– are subject to court orders
– are pressured into treatment by employers, family or friends
• Counselling is not suitable for those who:
– are actively psychotic
– have significant cognitive impairment or intellectual impairment
– are grossly intoxicated.
Polydrug Use
A Final Comment
If the young polydrug user can be kept alive, and free of disease, there is a natural tendency towards eventually moderating or giving up drug use.
Treatment may provide ‘a nudge along the natural pathway of recovery’.
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