Illicit drug use

Problem use of illicit drugs refers to the use of illegal psychoactive substances in a way that is harmful or hazardous to health (Department of Health and Social Care, 2017). Use of these drugs can lead to dependence, which may result in cognitive, behavioural and/or psychological problems.

Frequent use of illicit drugs can cause people to:

• have difficulty controlling use
• persist in use despite harmful consequences
• give higher priority to drug use than to other activities and obligations
• have increased tolerance to the drug
• enter a state of physical withdrawal (National Institute for Health and Care Excellence (NICE), 2017)

Illicit drugs can be taken either intravenously or orally, via snorting (through the nose), ingestion or smoking.

There are a number of illicit addictive drugs, but the most common types that can lead to addiction and/or health risks are:

• stimulants
• opioids
• benzodiazepines
• sedative pills (Camden and Islington NHS Foundation

Stimulants

The most common withdrawal symptoms from crack cocaine use include:

• paranoia
• severe agitation
• mood swings
• delusional behaviour
• sweats
• increased pulse rate (Department of Health and Social Care, 2017)

Opioids

Benzodiazepines

The most common withdrawal symptoms from benzodiazepine use include:

• sweats
• high pulse and blood pressure
• extreme anxiety
• restlessness
• agitation
• mood swings
• paranoia
• confusion
• pressured speech
• hallucinations (Mind, 2021)

The exact cause of drug use disorder is not known. Factors involved in the aetiology of problem drug use, as well as addictive behaviour, include:

• genetics
• the action of the drug
• peer pressure
• emotional distress
• anxiety
• depression
• environmental stress (Department of Health and Social Care, 2017)

A total of 275 896 adults were in contact with drug and alcohol services between April 2020 and March 2021 (Office for Health Improvement and Disparities, 2021). In the same year, more men (68%) received treatment for problem drug use than women (Office for Health Improvement and Disparities, 2021).

Between 2020 and 2021, drug-related deaths in treatment increased to 3726 deaths, equivalent to 1.4% of all adults in treatment (Office for Health Improvement and Disparities, 2021). This death rate increased by 27% from the previous year, demonstrating the need for wider knowledge of problem drug use and appropriate treatment approaches.

In the UK, the

Stimulants

Psychological-based interventions have been useful when treating patients with severe stimulant use (Camden and Islington NHS Trust, 2022). Methadone can also be prescribed as a treatment, particularly in cases of crack cocaine and heroin use (Department of Health and Social Care, 2017). Treatment options will be explored further in the opioid section.

Opioids

People who present with a dependent pattern of opioid use are often prescribed methadone or buprenorphine. Methadone is a synthetic opioid, which causes no withdrawal symptoms when taken in place of traditional opioids, and does not result in the psychological ‘high’ often associated with heavy daily opioid use.

It is important to prescribe the correct dose of methadone, which is usually dictated by the amount of opioid used daily. For example, 0.5 g of street heroin can usually be effectively treated with 40 mg of methadone.

Starting doses of methadone should range from 10 mg to

Camden and Islington NHS Foundation Trust. Co-occuring mental health and drug & alcohol misuse policy. 2022. https://www.candi.nhs.uk/sites/default/files/Co-occurring%20Mental%20Health%20and%20Drug%20%26%20Alcohol%20Misuse%20Policy%20May%202022.pdf (accessed 6 July 2023)

Department of Health and Social Care. Drug misuse and dependence: UK guidelines on clinical management. 2017. https://www.gov.uk/government/publications/drug-misuse-and-dependence-uk-guidelines-on-clinical-management (accessed 6 July 2023)

Fernandez J. Guideline on how to treat patients who present to primary health care services in Islington with the dual problem of alcohol and opioids. 2015. https://www.whittington.nhs.uk/document.ashx?id=6192 (accessed 6 July 2023)

Hull and East Riding Prescribing Committee. Prescribing Guideline for Prescribing Guidelines for Benzodiazepines in Adults. 2021. https://www.hey.nhs.uk/wp/wp-content/uploads/2016/03/benzodiazepines.pdf (accessed 17 July 2023)

Mind. Sleeping pills and minor tranquillisers. 2021. https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/withdrawal-effects-of-benzodiazepines/ (accessed 17 July 2023)

National Institute for Health and Care Excellence (NICE). Drug misuse prevention: targeted interventions. 2017. https://www.nice.org.uk/guidance/ng64 (accessed 6 July 2023)

Office for Health Improvement and Disparities. Adult substance misuse treatment statistics 2020 to 2021: report. 2021. https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2020-to-2021/adult-substance-misuse-treatment-statistics-2020-to-2021-report (accessed 6 July 2023)