Assessment for first presentation

• on the first visit, the patient should receive an initial assessment, which identifies problems and immediate needs
  • following this, work should be carried out to establish if the patient is accessing any other services. If so, and with the patient’s consent, the other services involved in their care should be contacted and a lead care coordinator appointed to make sure that duplication of any work is minimised and the patient receives a care package suitable to their needs
  • assessment is similar to other patients who present with drug problems:
    • current drug and alcohol use - useful to ask about a ‘typical using day’ and a ‘typical using week’ (this can help to establish stereotypical patterns of drug use that might otherwise appear harmless or innocuous to the cocaine user). It also identifies runs of drug use and binge patterns that can be usefully addressed in treatment sessions later. It also helps to establish the depth of ‘harmful use’ versus ‘dependent use’
    • method and route of use of drugs
    • drug and alcohol history including previous treatment
  • physical health: current and past medical history including change in weight, breathing problems, chest pains and sexual health
  • psychological and mental health: general mood and current mood, noting swings; how feeling, whether anxious or depressed
    • disturbance of sleeping patterns
    • risk of self-harm, suicide
    • phobias, obsessions, paranoia and hallucinations
    • past mental health history
  • social situation and forensic history:
    • relationships, partner, family, children
    • accommodation, employment, money concerns
    • past and present contact with the criminal justice system
  • examination
    • undertake a physical and mental health examination including: general health and complications of use, such as burns to lips, nose or thumbs, damage to nasal septum, and inspect injecting sites for damage and infection
    • check teeth and gums for signs of disease
    • pulse and blood pressure
    • weight, height and body mass index
    • measure peak flow
    • examine the heart and if indicated arrange an ECG
    • check full blood count, liver and kidney function
  • screening:
    • urine drug screen and/or oral fluid tests
    • offer hepatitis B and C and HIV (and hepatitis A if injector) screening and vaccinate as necessary
    • cervical smear where appropriate
    • sexually transmitted infections (STIs) including chlamydia screen.

Notes:

• remember that many users are not just using cocaine but may be combining it with heroin, methadone, alcohol, benzodiazepines, amphetamines, ecstasy, ketamine and sildenafil (Viagra) etc

Reference:

• (1) RCGP (2004). Guidance for working with cocaine and crack users in primary care