Session O1RC4: Recreational drugs: anaesthesia and intensive care implications

Session O1RC4: Recreational drugs: anaesthesia and intensive care implications

Monday 4 June, 14h00-14h45, Purple Room

Anaesthesiologists must regularly deal with people intoxicated with recreational (illegal drugs). “The medical definition of recreational drugs (such as cocaine, marijuana, or methamphetamine) is a drug used without medical justification for its psychoactive effects, often in the belief that occasional use of such a substance is not habit-forming or addictive,” says Professor Jonathan Thompson, Editor-in-Chief, BJA Education, and Consultant in Anaesthesia & Critical Care, University Hospitals of Leicester NHS Trust, UK.

“Recreational drugs” is a loose term that refers to legal and illegal drugs that are used without medical supervision. There are four categories of recreational drugs: analgesics, depressants, stimulants, and hallucinogens. Analgesics include narcotics like heroin, morphine, fentanyl, and codeine; depressants include alcohol, barbiturates, tranquilizers (GABA ergics)- GHB and GBL; stimulants include cocaine, amphetamine, methamphetamine, mephedrone and ecstasy (MDMA). Hallucinogens include LSD (acid), psilocybin (magic mushrooms), and ketamine,

For the ICU or emergency patient intoxicated by these drugs, general management principles include providing basic life support and airway management, obtaining intravenous (IV) access, vital sign monitoring, reviewing all potential medications the patient may have access to, a focused examination, including evaluation of pupils and a search for transdermal patches and signs of injection drug use, such as “track marks,” an electrocardiogram, and basic laboratory work to review renal and liver function and to exclude other causes such as infection or myocardial infarction, as well as urine and serum toxicology.

“Agitation can occur and results from intoxication or withdrawal. Management can depend on the substances used. Benzodiazepines are often used, with antipsychotics as second line. It is best to avoid restraints, since these can worsen agitation or increase risk of sudden death, especially with stimulants,” explains Professor Thompson. “Withdrawal can often complicate ICU management of other illnesses.”

Professor Thompson will also discuss prevalence of illicit drug use in Europe, and the factors that can affect, for example, addiction to common prescription drugs such as Xanax. He will also discuss the warning signs of commonly abused drugs, and the effects each can have on treatment course in the ICU.