Useful information about Recreational Drug Problems

Who to call

Liaison Psychiatry

Office hours: for urgent or semi-urgent referrals or to discuss informally, contact Liaison Psychiatry Registrar
After-hours: contact Liaison Psychiatry Nurse Specialist (until 2300h/7 days a week)

CADS Detoxification Medical Officer on call (available 24/7) or via Pitman House Detoxification Unit (24/7).

Auckland Opioid Treatment Service (AOTS)

For general enquiries or to speak to an AOTS doctor or keyworker (0830-1630h)
For AOTS pharmacy (0900-1200h, including weekends and public holidays)
After hours, contact the CADS Detoxification Medical Officer on call 24/7

For nicotine-dependent patient referrals to ADHB Smokefree Services (voicemail) or via eReferral.

Common problems

When to call

If you are uncertain about the severity of alcohol or drug dependence and/or management, especially where there is polysubstance use.
If there are concerns about the patient’s mental state in the context of intoxication/withdrawal.

Be aware that alcohol, GHB/GBL and benzodiazepine withdrawal syndromes are potentially extremely hazardous/life-threatening. Although other withdrawal syndromes are uncomfortable and may cause considerable distress, they are not as clinically risky.

CADS referral pathways

Fax through elective detoxification referrals.
With patient consent, you can refer directly for CADS counselling support via online referral
Patients can self-refer via 0800 845 1818.
Patients can also self-present at the walk-in clinic at CADS, Central 1st Floor, 409 New North Rd, Kingsland, weekdays between 1000-1300h

Alcohol and Substance Use History

How much alcohol, how often, time of last drink, recent change in drinking, any negative effects (blackouts, previous withdrawal/withdrawal seizures, legal, self-harm/suicidal behaviours while intoxicated, harm while intoxicated, including inability to keep self safe from situations and others, health or relationship problems, etc.).
Use of other substances – which drugs, how much, how often, prescribed / illicit / OTC, time of last use, mode of use, negative effects including health-related problems.
Current symptoms of withdrawal, severity.
For alcohol-related presentations, complete an AUDIT-C if any concerns about possible withdrawal Symptoms – See ADHB Withdrawal Guideline.

The history from the patient may be unreliable if significant intoxication or withdrawal. Obtain a history from significant others, if possible, especially if the history is inconsistent with the physical findings.

Examine

For signs of intoxication or withdrawal
- Alcohol: anxiety, tremor, restlessness, sweating, tachycardia, hypertension, vomiting, diarrhoea and eventually confusion/hallucinations
- Drugs: see sections 3 and 4
For evidence of alcohol or drug-related disease (hepatic, gastrointestinal, neurological, endocrine)
For signs of IV drug use on arms, legs, groin, neck (needle marks, localised inflammation/infection, old scarring)

Investigations

Toxicology: serum ethanol, urine drug screen (note: results take >24 hours; standard panels do not detect all drugs of abuse, including zopiclone, tramadol, oxycodone, methadone, methylphenidate, etc.)
Haematology: FBC (macrocytosis, thrombocytopenia)
Biochemistry: LFTs (GGT is often, but not always, most sensitive)
Serology: hepatitis B and C tests, HIV test

Brief Intervention

All patients with alcohol or other drug problems should receive a brief intervention.

Help the patient identify some “not so good things” or problems related to their use.
Give factual information about recommended use guidelines, for example, low-risk alcohol advice: http://www.alcohol.org.nz/help-advice/advice-on-alcohol/low-risk-alcohol-drinking-advice.
Advise how to access help.
If the patient is resistant to your intervention, do not persist.