Dr Arun Dhandayudham Joint CEO and Medical Director WDP Feb Pharmacological Management of Opiate and Benzo Dependence in older people

Transcription

1 Dr Arun Dhandayudham Joint CEO and Medical Director WDP Feb 2018 Pharmacological Management of Opiate and Benzo Dependence in older people

2 Epidemiology Who is an older person NDTMS Data

3 Whats Happening in Substance Misuse?

4 Very Little Opiate Neurobiology!!!! Mu1 Analgesia and euphoria Mu2-Constipation and respiratory depression Kappa-Spinal Analgesia and Dysphoria Delta-unkown Opiates modulation and other drugs of abuse

5 A walk through the system ENTRY TRIAGE MEDICAL ASSESSMENT OST STABILISATION REDUCTION DETOX

6 MEDICAL ASSESSMENT 1 Current Substance Misuse Is there a dependency? On what

7 Medical Assessment 2 Past Drug and Alcohol Hx

8 Medical Assessment 3 Medical Hx

9 MEDICAL ASSESSMENT 4 Psychiatric History

10 MEDICAL ASSESSMENT 5 Social Situation

11 MEDICAL ASSESSMENT 6 Motivation Goals Insight Want Putting it all together!!!

12 OST OPTIONS 1 Methadone

13 OST Options 2 Buprenorphine

14 What happens in the treatment system Keyworking GPSC Contingency Management Supervised Consumption Prenoxad

15 Reductions and Detoxifications IP OP Lofexidine Syptomatics

16 Relapse Prevention and Aftercare

17 Some thoughts about Benzos

18 An Aspirational Practical Way of Enhancing Treatment Delivery What substance misuse services could Example do additionally 1 for physical health Entry into substance misuse services What substance misuse services could do for mental health Full physical screening: At start At least annually Physical examination to include: Blood pressure and pulse rate ECG Blood sugar level BBV testing COPD status Blood tests- U&E, FBC, GGT Pain assessment MMSE Oral health check Co-working and Co-location with: GP Surgeries Diabetic Clinics COPD Clinic Cardiology Gastroenterology Sexual Health Clinics Dentistry Substance misuse triage covering: Illicit drug use Alcohol use GP summary Past drug and alcohol history Current and past mental health Current and past physical health Social situation issues Regular Reviews To cover the above areas and work with other local services One to one and group work to cover: Substance misuse issues Substance specific groups Relapse prevention Healthy lifestyle Weight management Smoking Life skills Community reintegration Education and skills Exercise groups Sleep hygiene Coping skills Screen for: Anxiety Mood Previous psychiatric input Current psychiatric input Mental health needs Collaborate with: OPMH service to optimise treatment within SM services And co-work with OPMH for patients with more serious MH needs

19 What OPMH services could do with regards to physical health Entry into OPMH Services What OPMH services could do with regards to substance misuse Full physical screening: At start Annually Physical examination to include: Blood pressure and pulse rate ECG Blood sugar level BBV testing COPD status Blood tests- UDE, FBC, GG7, LF7 Pain assessment Oral health checks Co-working with: GP Surgeries Secondary hospital services Diabetic Clinics COPD Clinic Cardiology Gastroenterology Sexual Health Clinics Dentistry Initial Appointments covering: Reasons for referral Mental health symptomology Substance misuse Physical health Social situation needs Regular Reviews To cover the above areas and wok with other local services Verbally Screen for: Illicit drug use NPS Alcohol issues Benzodiazepine use AUDIT/CAGE screens BBV testing Breathalyse /UDS/Saliva Test Blood tests FBC, U&E, GGT, LFT Brief Advice Work and Collaboration To collaborate with SM services to optimise services for clients Collaborate with SM services for more complex patients To use SM service expertise in group work/contingency management Substance misuse Benzo groups Cannabis and stimulant use groups Coping skills Relapse preventions Healthy lifestyle Weight management Smoking Community integration Education and skills Exercise groups Sleep hygiene Coping skills