Is this patient intoxicated with marijuana?
Does marijuana cause withdrawal?
How is hallucinogen intoxication managed?
How is gamma-hydroxybutyrate (GHB) overdose treated?
What medical problems are caused by inhalants?
Patients may be admitted to a hospital with an overdose, intoxication, or withdrawal syndrome from drugs of abuse. More commonly, patients admitted with medical problems or trauma may be abusing illicit drugs and may develop complications of this during their inpatient stay. It is important to ask all patients about drug use. Recognition of problems due to drug abuse can help clinicians provide optimal care to hospitalized patients.
There are many different drugs that may be abused. In the hospital setting, certain classes of drugs of abuse are more likely to be encountered due to the high prevalence of use outside a hospital setting or due to medical consequences of use. Alcohol abuse is widely prevalent and encountered in hospital settings due to intoxication or withdrawal. Cocaine use may result in exacerbation of angina or asthma. Other drug classes are encountered less frequently in hospital settings due to lower prevalence of overall use, as well as lower incidence of severe medical complications. It is worthwhile for practitioners to be aware of these complications, which are often related to acute intoxication but may also be due to withdrawal. This chapter covers adverse effects of marijuana, hallucinogens, other “club drugs” such as gamma-hydroxybutyrate (GHB), and inhalants.
Hospitalized patients will frequently be using more than a single drug. Polysubstance abuse is the norm, rather than the exception. Patients diagnosed with one substance use disorder (SUD) will often have another SUD. For example, nearly all patients with hallucinogen dependence also abuse alcohol. It is important to ask patients directly about all illicit drug use. Many patients are forthcoming with medical personnel if they are asked in a nonjudgmental manner. Other clues from a thorough physical examination and some common laboratory tests can help establish a diagnosis of recent drug use (Table 236-1).
Table 236-1 Indicators of Drug Use Disorders ||Download (.pdf)
Table 236-1 Indicators of Drug Use Disorders
|Conjunctival injection||Current use||Marijuana|
|Pinpoint pupils||Intoxication, overdose||Opioids|
|Nasal septal perforation||Vasoconstriction||Any snorted drug|
|Sores, hyperpigmentation around mouth and/or nose||Chemical irritation||Inhalants|
|New murmur||Endocarditis from injection drug use||Any injected drug|
|Track marks, fresh needle marks||Injection drug use|
|White blood cell count low||Human immunodeficiency virus|
|Transaminases (alanine aminotransferase, aspartate aminotransferase) elevated||Viral hepatitis|
|Urine drug screen positive||Recent drug use||Marijuana, phencyclidine, stimulant, opioid, benzodiazepine|
Some patients are able to use illicit substances while hospitalized. They may bring drugs and possibly paraphernalia with them at admission (in clothing, a purse, or other possessions), or visitors may bring drugs to a patient sometime during the hospitalization. Occasionally a patient may obtain drugs from ...