Substance misuse

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There are loads of substances that people abuse. (Alcohol abuse is considered alone.)

  • Opiates: Heroin, Methadone, Codeine, Morphine and Opium. Main effect is euphoria. Apparently, its rather good.
  • Stimulants: Cocaine, Crack, Ecstasy, Amphetamine. Hyperactivity, euphoria, aggression.
  • Hallucinogens: LSD, Magic Mushrooms. Marked perceptual disturbances, crazy ideas.
  • Weed: "Woah! Gets you stoned man..."


Paracetamol overdose and acute problems you develop from alcohol abuse.


In heroin overdose, give naloxone. One of the symptoms of opiate overdose is respiratory depression. They may even develop type 2 respiratory failure if it's really bad. Test for it using urine


Overdose leads ot psychosis, chest pain, hypertension. Treat with an antipsychotic - olanzapine or risperidone preferably (fewer side-effects) but are more expensive. Haloperidol is a less expensive alternative.


CNS symptoms: sleepy, double vision, imparied balance, impaired motor function, anterograde amnesia, ataxia, slurred speech. Psych symptoms: anxiety, delirium, combativeness, hallucinations, aggression. GI: Nausea and vomiting

Severe overdose: coma, apnoea, respiratory depression, hypoxaemia, hypothermia, hypotension, bradycardia, cardiac arrest, aspiration. Occur 12-36 hours after ingestion of drug.

Treatment - supportive measures: maintaining airway, fluid replacement, atropine for bradycardia; and flumazenil.