3. Street Drugs - Australia
ED’s biggest bain remains:
– ETOH
– Smoking
Emerging concerns:
– Prescription drug abuse
– Synthetic derivatives of old
4. Street Drugs in ED
• Resource intent
• Challenging personas
Stats:
• Amphetamines in ED 1.2% presentations
(Gray, 2007, MJA)
• July 2010-12 Vic ambulance
• 318% increase in amphetamine related call
outs
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(Helibourne, 2013, MJA)
7. Case 1
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28 female
Known polysubstance abuse
Presents agitated, & diaphoretic
Vitals: BP 172/89, HR 128, RR 30, Temp 37.9
Given IVIH, IV Diazepam – symptoms settle
• Admits to smoking “spice”
8. Synthetic Canabinoids
• “K2” “Spice” – “legal Marijuana”
• Typically sold – “incense” “room fresheners”
• Labeled - not for human consumption
• Sold OTC or Internet - $20-30
9. Synthetic Canabinoids
• Difficult to detect
Contains:
• Herbs/vegetables sprayed chemicals
• Target CB1 receptors in brain
Generally smoked
– Can be injected (tea), baked (cookies)
12. Case 2
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22 male BIB Police
Found - agitated, palpitations, paranoid
Smoke some “Crystals”
Brought it of the net!
Vitals: BP 185/96, HR 142, Temp 38.2
23. Nurofen Plus Abuse
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Emerging problem
Its all about the codeine
Cheap – available OTC
Each tablet 200mg nurofen/12.8mg codeine
Reports pt’s abusing 60-100 tablets/day
24. The Issues
• Renal tubular acidosis
• Metabolic complications:
– Hypokalaemia
– Hyperchloraemia
– Hypophosphataemia
• GI Bleeds
29. Street Drugs in 2013
• Countless new agents
– Cheap & easily available
• Generally structurally variants of old
• Toxicity somewhat predictable
• Management principles largely the same