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GEM - Curriculum Statement 15.3 Drug and Alcohol Problems

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Knowledge Base for the nMRCGP

Curriculum Statement 15.3 Drug and Alcohol Problems

Symptoms and signs:

Emboldened terms are linked to GPnotebook entries.

Of opiate misuse – needle track marks, pinpoint pupils, runny nose, drowsiness
- heroin misuse section on GPnotebook
Of stimulant use – agitation, skin ulceration
- amphetamine misuse section on GPnotebook
Suggestive of cannabis use – red eyes, irritability, anxiety, panic disorder
- cannabis misuse section on GPnotebook
Manifestation of alcohol problems:
- physical: accidents, victim of violence, obesity, dyspepsia, erectile dysfunction, fits, foetal alcohol syndrome, liver damage, anaemia, neurological and central nervous system problems
- psychological: anxiety, depression, attempted suicide
- social: loss of employment, disorderly conduct, domestic violence, drink–driving, relationship problems or breakdown
- alcohol misuse section on GPnotebook
- Wernicke-Korsakoff syndrome
- delerium tremens
- neurological complications of alcohol misuse on GPnotebook
- gastrointestinal complications of alcohol misuse on GPnotebook
- cardiovascular complications of alcohol misuse on GPnotebook
- haemopoiec complications of alcohol misuse on GPnotebook
- genitourinary complications of alcohol misuse on GPnotebook
- psychological complications of alcohol misuse on GPnotebook

Common and/or important conditions:

The common complications of drug-using or misusing habit:
- those related to the drug used (e.g. heroin, cocaine, alcohol, cannabis)
- those related to the route of use (such as injecting, inhalation)
- those related to the lifestyle related to a drug-using habit (poor nutrition, poor dentition, social problems).
Have an understanding of the aetiology, presenting symptoms, treatment and prevention of HIV infection, hepatitis A, hepatitis B, hepatitis C
The health and social burden of excess alcohol consumption.

Investigations:

Have an understanding of the nature and role of urine, and other tests in the management of drug treatment
- urine screening in drug misuse
The use of screening tools for alcohol such as Cut down Annoyed Guilty Eye-opener (CAGE) and Alcohol Use Disorders Identification Test (AUDIT)
- CAGE questionnaire on GPnotebook
- AUDIT on GPnotebook

Treatment:

the National Clinical Guidelines for the care and management of a drug-using patient
the principles and practice of appropriate safe prescribing for patients who use drugs
the principles and practice of dose induction and safe prescribing for the drug-using patient
The range of treatment interventions available including pharmacological interventions
The impact that health professionals can make by providing brief intervention for excess alcohol use

Emergency care:

Have an understanding of the aetiology and prevention of drug-related deaths
Alcohol-related emergencies such as fits, delirium and psychosis

Prevention:

Have an understanding of the term harm reduction, the strategies that can be employed in harm reduction and the advantages and disadvantages of undertaking a harm reduction approach to treatment.

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GEM - Curriculum Statement 15.3 Drug and Alcohol Problems

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