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Clinical Practice Guidelines

Recreational drug use and overdose


  • Statewide logo

    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also

    Poisoning - Acute guidelines for initial management

    High Risk Low Dose Paediatric Ingestions

    Acute behavioural disturbance: Acute management


    For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26  

    Background

    Most recreational drug related presentations for acute health intervention in Australian adolescents involve alcohol, frequently in combination with other agents.  The drugs / toxins to be considered include:           

    • Amphetamines
    • Cannabis
    • GHB
    • Hallucinogens
    • Inhalants/Volatile Substance Abuse
    • Opiates 

    Drug

    Also known as

    Assessment

    Investigations

    Management

    Notes

    Amphetamines 

    (small dose may produce significant toxicity)

    Ice, speed, gooey, whiz, base, ecstasy, love drug, MDMA, MD

    Central & peripheral sympathomimetic effects:

     -  agitation, sweating, tachycardia, hypertension

    Medical complications:

    - severe hyperthermia, rhabdomyolysis, seizures, intracranial haemorrhage, hyponatraemia, cerebral oedema

    - 12 lead ECG

    - BSL

    - Electrolytes & renal function, CK, troponin 

    - Consider intracranial imaging if any concern regarding vascular dissection

    Safe, low stimulus environment 

    Continuous cardiac monitoring 

    Benzodiazepines to control agitation

    		  

    Cannabis 

    (dose related effects)

    Marijuana, grass, pot, weed, ganja, dope, hashish

    Mild sedation, euphoria, disinhibition progressing to CNS depression, anxiety & psychotic symptoms, postural hypotension & tachycardia

    N/A

    Benign symptoms: 

    - supportive care until asymptomatic 

    Anxiety:

    - Diazepam 

    Cardiovascular effects: - IV fluids

    		  

    Gamma-Hydroxybutyrate (GHB)

    G, fantasy, easy lay, grievous bodily harm, cherry meth, liquid E

    CNS & respiratory depression progressing to coma

     

    Bradycardia & myoclonic jerks

    N/A

    Resuscitation environment

     

    Expect improvement within 4-6 hours

    Hallucinogens

    Datura sp., Angels trumpet, magic mushrooms, LSD

    Central & peripheral anti-cholinergic toxidrome

    - agitation, delirium, hallucinations, mydriasis, tachycardia, dry flushed skin

    N/A

    Supportive care 

    Treat delirium with titrated diazepam

    Anti-psychotic major tranquilisers (eg haloperidol) may worsen anti-cholinergic symptoms

    Inhalants/Volatile Substance Abuse

    Huffing, bagging, sniffing, chroming

    Similar effects to alcohol intoxication:

    - initial euphoria & disinhibition followed by CNS depression 

    Acute medical complications:

    - sustained 'high', encephalopathy & seizures, methaemoglobinaemia, cardiac arrhythmia & sudden death

    		  

    Treat behavioural disturbance/delirium with diazepam

     

    Cardiac arrest resuscitation should limit the use of exogenous adrenaline

    		  

    Opiates

     

    CNS & respiratory depression associated with miosis 

    Dextropropoxyphene (Digesic) - seizures & arrhythmias 

    Tramadol - seizures & serotonin syndrome

     

    Monitor for CNS & respiratory depression 

    Airway protection & ventilation ensures good outcome 

    Naloxone infusion

    (note short half life) 

    Treat seizures with benzodiazepines and phenobarbitone

    		  

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650. 

    Notes

    This guideline has a limited scope, addressing the acute issues of adolescent recreational drug use.  A number of resources are available for further information, fact sheets and assistance with chronic management.  These include:
    RCH Department of Adolescent Medicine
    On line resources:
    Australian Drug Foundation (http://www.adf.org.au)
    National Drug and Alcohol Research Centre (www.ndarc.med.unsw.edu.au)