1. Substance Abuse and Misuse

2. You Are the Emergency Medical Responder
Lesson 25: Substance Misuse and Abuse
You Are the Emergency Medical Responder
Your emergency medical services (EMS) unit is summoned to a residence on a report of an unconscious person. When you arrive and size-up the scene, you discover an older couple. The wife is distraught and says that her husband had been drinking alcoholic beverages heavily earlier in the day. Shortly after taking his prescribed Valium®, she says he became drowsy and incoherent, and then collapsed. Unable to get him to respond, she called On assessing the patient, you find that he is unresponsive, his breathing is shallow and slow, his heart rate is slow and his pulse is weak.

3. Substance Abuse and Substance Misuse
Abuse: The deliberate, persistent and excessive use of a substance without regard to health concerns or accepted medical practices
Misuse: The use of a substance for unintended purposes or for appropriate purposes but in improper amounts or doses
Includes use of illegal (or illicit or controlled) substances and legal substances, such as nicotine, alcohol and over-the-counter (OTC) medications, such as sleeping pills and diet pills

4. Substance Abuse Terms Dependency – the desire to continuously use
Addiction – compulsive need for the substance
Withdrawal – stop using when addicted
Tolerance – effects on the body decrease
Overdose – excessive amount of the substance
Synergistic effect – two or more substances used at the same time – can be fatal

5. Categories of Abused Substances
Stimulants – central nervous system
Hallucinogens – alters time and space
Depressants – central nervous system
Narcotics – act as a depressant
Inhalants – depresses the central nervous system
Cannabis products – impaired judgment and motor coordination

6. Stimulants Effects on the body: Increased physical and mental activity
Temporary feelings of alertness
Appetite suppression
Energy bursts
Examples:
Amphetamine, dextroamphetamine, methamphetamine
Cocaine
Crack cocaine

7. Stimulant Overdose Signs and Symptoms
Moist or flushed skin
Sweating, chills
Nausea or vomiting
Fever
Headache
Dizziness
Rapid pulse
Rapid breathing
High blood pressure
Chest pain
Possible respiratory distress
Excitability, restlessness, talkativeness or irritability
Possible sudden loss of consciousness

8. Hallucinogens Effects on the body:
Changes in mood, sensation, thought, emotion and self-awareness
Altered perception of time and space
Visual, auditory and tactile delusions
Examples:
Lysergic acid diethylamide (LSD)
Psilocybin
Phencyclidine (PCP)
Mescaline (angel dust)

9. Hallucinogen Abuse Signs and Symptoms
Sudden mood changes
Flushed face
Claims of seeing or hearing something not present
Anxiety or fear

10. Depressants Effects on the body:
Decreased physical and mental activity
Altered level of consciousness (LOC)
Depressed respirations
Impaired coordination and judgment
Examples:
Barbiturates
Benzodiazepines
Ketamine
Rohypnol
Gamma-Hydroxybutyrate (GHB)
Alcohol

11. Depressant Abuse Signs and Symptoms
Drowsiness
Confusion
Slurred speech
Slow heart and breathing rates
Poor coordination

12. Alcohol Withdrawal Signs and Symptoms
Confusion and restlessness
Delirium tremens (DTs)
Hallucinations
Seizures

13. Narcotics Effects on the body: Depression Pain relief Examples:
Morphine
Codeine
Heroin
Oxycodone

14. Inhalants Effects on the body: Mood altering
Depression of central nervous system
Erratic blood pressure and pulse
Examples:
Amyl nitrate
Nitrous oxide
Solvents

15. Cannabis Products Effects on the body: Feelings of elation
Distorted perceptions of time and space
Impaired judgment and motor coordination
Examples:
Marijuana
Hashish

16. Signs of Cannabis and Inhalant Use
Cannabis: red, bloodshot eyes
Inhalants: drunken or disoriented appearance (similar to hallucinogen abuse)

17. Other Substances Designer drugs
Methylenedioxymethamphetamine (MDMA - “ecstasy,” “E”)
Anabolic steroids – juice, roids, vitamins
OTC medications, such as aspirin, nasal sprays
Laxatives and emetics (ipecac)
Anorexia Nervosa
Bulimia

18. General Principles of Care
Size-up the scene
Perform a primary assessment
Summon more advanced medical personnel
Perform a physical exam
Take a SAMPLE history to try to find out what substance was taken, how much was taken and when it was taken
Calm and reassure the patient
Keep the patient from getting chilled or overheated
Keep the patient’s airway clear
If the patient has difficulty breathing, administer emergency oxygen, if available

19. Factors Contributing to Substance Abuse
Lack of parental supervision
Breakdown of traditional family structure
Wish to escape unpleasant surroundings and stressful situations
Widespread availability of substances
Peer pressure and the basic need to belong
Low self-esteem, including feelings of guilt or shame
Media glamorization promoting the idea that using substances enhances fun and popularity
History of substance abuse in the home or community environments

20. Prevention Guidelines and Unintentional Misuse or Overdose
Read the product information; use only as directed
Ask a doctor or pharmacist about intended use and side effects; if taking more than one medication, check for possible interaction effects
Never use another person’s prescribed medications
Always keep medications in their original, marked containers
Discard all out-of-date medications
Keep medications out of reach of children

21. You Are the Emergency Medical Responder
Based on your findings, you suspect that the patient ingested a combination of drugs and alcohol.