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Name the stages of drug abuse
Stage I: experimentation
Stage II: recreational use
Stage III: problematic use
Stage IV: addiction
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What are the two forms of cocaine?
Hydrochloride: soluble, injected
Freebase: lower bp, less soluble, vaporised and inhaled
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What are the different types of cannibis and how much active compound do they contain?
Marijuana: up to 10% THC
Hashish: up to 15% THC
Oil: up to 30% THC
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What drugs are contained in class A?
- Ecstacy
- LSD
- Heroin
- Cocaine
- Crack
- Magic mushrooms
- Amphetamines (if prepped for injection)
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What drugs are contained in class B?
- Amphetamines
- Methamphetamine
- Pholcodine
- Cannabis
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What drugs are contained in class C?
- Buprenorphine
- Tranquilisers
- Some painkillers
- GHB
- Ketamine
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What are the risks of using heroin?
- OD
- HIV/other infections
- Damage to veins
- Physical dependence leading to crime
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How can we reduce the harm associated with injecting?
- Needle exchanges
- Education
- Provide clean, sterile paraphenalia
- Accept return of used equipment for safe disposal
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How would you go about preparing freebase heroin into an acid salt to inject?
- Mix the freebase with ascorbic or citric acid (vinegar too strong and lemon juice has a risk of fungal infection) with water (ideally wfi but if not possible then clean e.g. bottled)
- Heat in a "cooker" (spoon held over a lighter)
- Draw through a filter into a syringe to remove particles (ensure the filter will not shed particles into syringe)
- Locate the vein (get to know arm to avoid valves), use a tourniquet, insert needle into vein and draw up some blood
- Inject the drug
- Withdraw the needle
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What paraphenalia can and can't be supplied as part of the needle exchange program?
- Can:
- Sterile "cookers"
- Citric acid (100mg sachets)
- Ascorbic acid (100mg sachets)
- Filters
- Alcohol swabs
- Water for injections
- Can't:
- Tourniquets
- Lighters
- Matches
- Night lights
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Do's and Don't's of preparation of drugs for injection
- Do:
- Wash your hands
- Use sterile equipment
- Prepare on a clean disposible surface
- Use your own cooker and filter
- Use the smallest amount of acid
- Reduce the amount of drug after a period of abstinence
- Don't:
- Use more than one drug
- Use lemon juice or vinegar
- Crush tablets
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Advice on injecting sites
- Peripheral veins are safer than deep veins
- It's better to have several injection sites and rotate them
Avoid femoral vein and veins in the breast, neck or penis
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Advice on injecting practice
- Use the smallest needle
- Use a tourniquet to identify vein and release prior to injecting
- Inject on the line of the vein towards the heart
- Use a shallow angle
- Inject slowly
- Apply pressure to site
Do not share equipment or inject alone
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Steps of the cycle of change
- Pre-contemplation
- Contemplation
- Determination to stop
- Action
- Maintenance
- Relapse
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Symptoms of opioid withdrawal
- Short term:
- Flu like - sweating, chills, piloerection
- Muscle twitching
- Diarrhoea
- Agitation
- Insomnia
- Long term:
- Anorexia
- Insomnia
- Lethargy
- Craving
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Stages of drug addiction treatment
Stage I: Maintenance - replace drug with legal alternative on Rx
Stage II: Withdrawal - aim to become drug free
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