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SCOTTISH ADVISORY COMMITTEE ON DRUG MISUSE: Psychostimulant Working Group Report
ANNEX G: DRAFT GUIDE TO PSYCHOSTIMULANTS FOR DATs
OUTLINE STRUCTURE
SECTION 1 INTRODUCTION AND BACKGROUND
Role of the SACDM Working Group (PSWG) - to identify for SACDM the issues around cocaine, crack cocaine and amphetamine use in Scotland; to look at the available evidence on best practice in prevention and service provision; and to make recommendations to SACDM.
The purpose of the guide is to set out current knowledge on psychostimulant use in Scotland drawing on the work undertaken by the PSWG.
Define 'psychostimulant'. For the purposes of the PSWG cocaine, crack cocaine and amphetamines were included in the exercise. Ecstasy was excluded. The Group's definition of psychostimulants will be used throughout the guide.
Description of the exercises undertaken by the PSWG that feed into the guide and a list of group members and invited speakers.
SECTION 2 WHAT ARE PSYCHOSTIMULANTS?
Cocaine (coke, charlie, snow) - white powder obtained from the leaves of the coca plant; powerful stimulant effects; snorting common, soluble cocaine sometimes injected; effects of snorted cocaine peak in 15-30 minutes
Crack cocaine (rock) - form of freebase cocaine that is purer and more concentrated; usually smoked and absorbed into the body faster than cocaine.
Amphetamine (speed, whizz) - speeds up the way your body works, usually for 4-6 hours; user feels more energetic, confident; amphetamine sulphate most common; can be snorted, dabbed from finger to mouth or injected. Smoking is not common.
SECTION 3 WHO USES PSYCHOSTIMULANTS?
Socio-demographic profile of users from research studies (age, gender, employment status etc); differentiate between opiate users (also using psychostimulants) and primary psychostimulant users; include data from Piper on primary psychostimulant users; include data from NTORs on both primary and secondary psychostimulant users.
Present summary of Scottish data from ISD / HEPs / SDEA with the appropriate caviats - drawing on work prepared by Paul and Sally for SACDM report; highlight lack of comprehensive source of information.
SECTION 4 NATURE OF PROBLEMS FACED BY USERS (including user's views)
Psychological problems - research studies illustrating psychiatric morbidity associated with psychostimulant use including anxiety, agitation, insomnia, depression; psychiatric symptoms found in 40% of stimulant users.
Physical health problems - information from research studies including heart disorders, overdose, cerebrovascular accidents, convulsions, seizures etc; issues for injectors (HIV / Hepatitis); mortality associated with accidents
Social problems - information from research studies including family breakdown, breakdown of other social relationships, associated criminal behaviour (property crime, violent crime), homelessness.
Users' views on the nature of the problems faced elicited in the course of the focus group work being conducted by SDF.
SECTION 5 TREATMENT / SERVICE PROVISION (including user's views)
Pharmacological treatment for cocaine users; research from the United States; lack of evidence to support any one treatment; focus on medications which relieve withdrawal rather than substitute; controlled trials on desipramine; systematic reviews of carbazepine; controlled trials of the clinical use of anti-depressants.
Pharmacological treatment for amphetamine users; evidence limited; limited benefits of fluoxedine, amlodipine, imipramine, desipramine; studies on dexamphetamine; controlled trial of dexamphetamine substitution underway at two centres funded by Department of Health
Psychological / psycho-social approaches; range of approaches have been tried (including CBT, relapse prevention, peer support etc), sometimes stand alone and sometimes in conjunction with symptomatic medication; number of studies currently underway including a brief intervention model for young injecting stimulant users.
Complimentary therapies; different approaches including acupuncture have bee tried; discussion of the role of these therapies as an adjunct to other treatments; briefly describe results of research studies including their possible role of retaining clients in treatment.
Models of service provision; describe and highlight examples / case studies of how services for psychostimulants have been designed and delivered
Users' views on how services should be designed and delivered to best serve the needs of psychostimulant users; data from research studies and from SDF focus group work in Scotland.
SECTION 6 SUMMARY OF KEY FINDINGS
Succinct, bullet-pointed section highlighting key findings from the PSWG materials used in the guide.
SECTION 7 REFERENCE MATERIALS / INFORMATION SOURCES
Materials referenced in the text
Further information sources (see below)
Cocaine / Crack
Drug Scope
www.drugscope.org.uk/druginfo/drugsearch/ds_results.asp?file=\wip\11\1\1\cocaine_crack.html
Drugfax (Scottish Drugs Forum) - section 5
NIDA (USA)
www.nida.nih.gov/Infofax/cocaine.html
Cocaine Anonymous
www.cauk.org.uk
Medline Plus
www.nlm.nih.gov/medlineplus/cocaineabuse.html
Amphetamines
Drugscope
www.drugscope.org.uk/druginfo/drugsearch/ds_results.asp?file=\wip\11\1\1\amphetamines.html
Medline Plus
www.nlm.nih.gov/medlineplus/amphetamineabuse.html
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