Let’s talk about the acute management of a drug overdose. Tragically, this is more common than we think.
As a patient comes in who is overdosed, it’s important first off to manage the ABCs.
You’ll see a lot of test questions where there’s a long paragraph describing a circumstance
and the answer really boils down to remembering the ABCs. So first, manage the airway,
then the breathing, and then the circulation. We should manage hypothermia or hyperthermia
which is common in drug use. In patients who have recently ingested a drug, GI decontamination
is important, so activated charcoal but this really only works within an hour of an ingestion.
For patients who have overdosed, naloxone is incredibly useful. We give naloxone and that opiate
is immediately relieved. But remember, many of the opiates of abuse have a longer half-life
than naloxone itself. So, if you give naloxone and then walk away from that patient and assume
everything is okay, in a few hours when that naloxone wears off, that patient may go right back
to their overdosed state. So, we need to admit these patients and watch them. I’m not mentioning
flumazenil because we don’t use it very often. We don’t use it because it causes seizure in patients a lot,
around 20% of the time. So, we don’t often reverse a benzodiazepine but we also may aggressively
manage aggressive behavior. If a patient is psychotic and angry and aggressive and dangerous,
we may give other drugs to reduce that response. For outpatient management of drug abuse,
counseling is the main stain of therapy. So, we are going to counsel these patients about and getting them
to be motivated through motivational interviewing to change their own condition.
Oftentimes, it’s important to set a specific quick date to get them motivated to fix their problem.
We will recommend frequent follow up appointments to check in to see how things are going.
When they have a slip, we say that’s part of it and then continue them forward rather than just give up
because they slipped. Outpatient psychological therapy is very important and a structured day program
may be indicated in patients with severe problems. There are sometimes indications for inpatient treatment.
For example, if detoxification off of is especially heroine or opiate is needed, that may need to happen
in an inpatient setting. We may recommend inpatient treatment if patients have a failure
to sufficiently respond to intensive outpatient therapy. We may recommend inpatient treatment
if patients are a danger to them self or to others or if there’s a severe medical or psychiatric comorbidity
to the problem. But remember, often insurance won’t pay for inpatient treatment. So, we have to work
through this financially with our families. So what are the complications of drug abuse?
Well, there’s the obvious one is that patients can overdose and they can die from that problem.
Alternatively, patients with IV drug abuse may suffer consequences of IV drug abuse
such as endocarditis, HIV, or hepatitis. The consequences of addiction are profound.
Patients may result in a life with theft, prostitution, criminal acts to sustain their drug activity.
Drug addiction is expensive and patients with drug addiction may not have the financial means
to maintain it. What’s key about drug addiction is prevention before patients get addicted.
We should provide guidance on substance abuse with adolescent patients in a therapeutic
and supportive way. Parents should be aware of adolescent activities but that’s a tough line to haul
because rarely do children who use drugs go first to talk to their parents. A lot of the important
parenting happens early in a child’s life before they’re interested in drugs so that they know
that the parent-child relationship is a strong one and one they can rely on. We need to help parents
recognize protective factors in drug abuse. We should help them understand that creating
a positive sense of self-esteem in a child goes a long way to preventing drug use, that supportive
family relationships are critical. And children should have positive role models.
They should have people they look up to who don’t use drugs, who they can admire.
That will inspire them not to have a life where they’re dependent on drugs for happiness or stability.
So, that’s my review of drug use in adolescents. Thanks for your time.