# Drug Abuse (Substance Use Disorder) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS16 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Opioid Use Disorder: Evaluation and Management - StatPearls (NCBI Bookshelf NBK553166) - https://www.ncbi.nlm.nih.gov/books/NBK553166/ - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Drug Abuse (Substance Use Disorder) - disease-level clinical article (drug-abuse-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text DRUG ABUSE (SUBSTANCE USE DISORDER) Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS16 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Opioid Use Disorder: Evaluation and Management - StatPearls (NCBI Bookshelf NBK553166) - https://www.ncbi.nlm.nih.gov/books/NBK553166/ Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Drug Abuse (Substance Use Disorder) - disease-level clinical article (drug-abuse-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Alcohol intoxication typically shows slurred speech, unsteady gait, and impaired judgment, which can progress to CNS depression, coma, and multiorgan failure [coma · drowsiness · slurred speech] - Cocaine and other stimulants produce anxiety, possible psychosis, and sympathetically driven vitals such as a fast heart rate, fast breathing, and high blood pressure [anxiety · hypertension · tachycardia · tachypnoea] - In the tolerance stage, larger doses are needed to reach the same high as before - In the dependence stage, physical withdrawal signs appear on stopping and the patient does not feel normal without the substance - A tolerant patient often presents with a story built around needing a higher dose or an unexpected early refill - Alcohol withdrawal ranges from autonomic dysregulation up to delirium tremens and seizures [confusion · seizures] SIGNS - what you find (2) - Opioid use produces parasympathetic signs - slow heart rate, low blood pressure, pinpoint pupils, low temperature, and sedation - with a risk of respiratory depression [bradycardia · hypotension · low mood] - Cocaine use shows a sympathetic pattern of a fast heart rate and fast breathing, sometimes with acute psychosis [tachycardia · tachypnoea] TESTS (8) - Chronic alcohol use can raise MCV with a megaloblastic anemia from folate deficiency - Acute intoxication shows an elevated anion gap with low CO2 and bicarbonate, an acidotic pattern - Methanol ingestion adds ophthalmologic problems, requiring serial eye exams - Ethylene glycol causes renal failure and oxalate kidney stones, so serial BUN/creatinine, GFR, and urinalysis for blood are needed - Cocaine use may need serial troponins, which are regularly elevated from coronary vasoconstriction - The Addiction Severity Index screens seven domains: medical, employment, drug use, alcohol use, legal, family/social, and psychiatric status - Reduced dopamine D2 receptors have correlated with decreased anterior cingulate and orbitofrontal activity in detoxified cocaine users - Substances such as kratom or bath salts need liquid chromatography, mass spectrometry, or ion mobility spectrometry since a standard urine drug screen misses them IF NOT THIS - what else fits (2) - Over half of those with a substance use disorder also have bipolar disorder, which can drive prominent mood swings - PTSD commonly co-occurs with alcohol abuse and should be screened for in every addicted patient Source StatPearls "Drug Addiction" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Use of a dependence-producing psychoactive substance causing intoxication, harmful use, dependence, or withdrawal; the GP's role is screening, harm-reduction advice, and referral to an addiction service for structured treatment, since substitution or withdrawal therapy needs specialist supervision. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Use of a dependence-producing psychoactive substance causing intoxication, harmful use, dependence, or withdrawal; the GP's role is screening, harm-reduction advice, and referral to an addiction service for structured treatment, since substitution or withdrawal therapy needs specialist supervision. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Substance intoxication can cause severe behavioral disruptions and suicidal tendencies. RED FLAG - Cocaine intoxication can lead to acute myocardial ischemia, psychosis, and fatal arrhythmias. RED FLAG - Overdose with reduced consciousness or slow breathing is an emergency; consider naloxone if an opioid overdose is suspected. Signs of withdrawal such as agitation, autonomic instability or seizures, and injecting drug use with its bloodborne infection risk, also need urgent referral. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)