Drug Abuse in Plastic Surgery Patients

The article (full reference below) is a reminder of drug abuse in our patients.  Many of which can create issue peri-operatively.  The article begins:

In 1957, Dr. George Crikelair detailed the impact of drug abuse on the practice of plastic and reconstructive surgery.   Five decades later, the subject remains salient: surveys administered by the White House Office of National Drug Control Policy (ONDCP) state that 41.7% of the U.S. population older than 12 has taken an illicit drug in their lifetime.  12.6% reported illicit drug use in the past year. 

….. This article seeks to impart clinical savvy regarding verbal and non-verbal cues of the seven most commonly abused drugs by detailing their pharmacology, clinical manifestations, screening and management, thus enabling plastic surgeons to provide prompt and appropriate treatment when encountering complications related to these
drugs.

I would recommend this article be read by more than just plastic surgeons.  It will either educate you or simply be a good review.  I’m not as good at picking drug abuse up as say Gruntdoc or Movin Meat or White Coat, so I found it worth my time.

To begin:

The typical urine drug screen (UDS) is based upon federal guidelines established by the Substance Abuse and Mental health Services Administration, or SAMHSA. This drug screen is referred to as the “SAMHSA-5” (and previously as the “NIDA-5”) because it detects only the five drugs required by federal workplace testing. These include cocaine, opiates, amphetamines, cannabinoids, and phencyclidine (PCP).

Synthetic opioids, such as oxycontin and hydrocodone, will not be noted on these routine screens.

The seven drugs the article reviews are:

Cocaine -- Common names: coke, blow, crack, snow, nose candy

Marijuana  -- Common names: pot, weed, grass, mary jane

Benzodiazepines  -- Common names: benzos, bars, tranks, normies, sleepers and xanies

Opioids  --  Common names: Heroin (H, smack, horse, brown/black tar), Prescription pain medication (oxy, roxy, vike, patches)

Amphetamines -- Common names: speed, uppers, dexies for amphetamine, and meth, crank, crystal, ice for methamphetamine

Gamma hydroxybutyrate --Common names: GHB, liguid Ex, G

Ecstasy  -- Common names: E, Adam, XTC, X, love drug

 

Each drug review includes pharmacology, clinical manifestations, screening, and management sections.   If you don’t have access to the journal, get your medical library to get it for you and READ the article.

 

REFERENCE

Drug Abuse in Plastic Surgery Patients: Optimizing Detection and Minimizing Complications; Cone, J.D., Harrington, M.A., Kelley, S.S., Prince, M.D., Payne, W.G., Smith, D.J.; Plast & Reconstr Surgery: POST ACCEPTANCE, 23 September 2010; doi: 10.1097/PRS.0b013e3181fad5ac