Drug misuse

Specific considerations
There is no evidence that substitution
therapy
helps. Treatment of withdrawal is
Amphetamine symptomatic.
Drug‐induced psychosis may need treatment
with
antipsychotics
Patients who misuse or have been on long‐
term
benzodiazepine prescriptions may
experience a
withdrawal syndrome if abruptly
discontinued.
Prevention is important – these medications
should ideally only be prescribed for short
trials of
Benzodiazepine 2–3 weeks
When tapering prescriptions of
benzodiazepines,
consider switching to a drug with a longer
half‐life
such as diazepam and reduce the dosage by
an
eighth every fortnight aiming to cease the
drug
within 6 months
There is no evidence that substitution
therapy
helps. Treatment of withdrawal is
Cannabis symptomatic.
Drug‐induced psychosis may need treatment
with
antipsychotics
There is no evidence that substitution
therapy
helps. Treatment of withdrawal is
Cocaine symptomatic.
Drug‐induced psychosis may need treatment
with
antipsychotics
Withdrawal syndrome can be severe – may
mimic
alcohol withdrawal but progress to severe
physical
GHB (γ‐
complications, psychosis, and delirium.
hydroxybutyrate)
Consider
inpatient treatment – seek specialist care.
Diazepam
and muscle relaxants may be helpful
 See specific algorithm. Opiate substitution
treatment, e.g. with methadone and
Opiate
buprenorphine,
is a specialist area