GEM - Curriculum Statement 15.3 Drug and Alcohol Problems

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)
    • heroin misuse section on GPnotebook
    • cocaine misuse section on GPnotebook
    • alcohol misuse section on GPnotebook
    • cannabis misuse section on GPnotebook
  • 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
  • HIV section on GPnotebook
  • hepatitis A section on GPnotebook
  • hepatitis B section on GPnotebook
  • hepatitis C section on GPnotebook
• 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
  • methadone and buprenorphine management - NICE guidance summary on GPnotebook
  • naltrexone with reference to NICE guidance
  • alcohol withdrawal management with reference to DOH guidance
• 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 first consultation with a heroin addict in primary care
  • methadone management in heroin misuse
  • buprenorphine management in heroin misuse
• The range of treatment interventions available including pharmacological interventions
  • methadone management in heroin misuse
  • buprenorphine management in heroin misuse
  • lofexidine in heroin misuse
  • naltrexone in heroin misuse
  • naltrexone in alcohol misuse
  • disulfiram in alcohol misuse
  • acamprosate in alcohol misuse
• 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
  • heroin misuse section on GPnotebook
  • cocaine misuse section on GPnotebook
  • cannabis misuse section on GPnotebook
• Alcohol-related emergencies such as fits, delirium and psychosis
  • 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

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.