Care of Persons with Substance-Related Health Conditions
Medical complications by substance
Candidates must recognize organ-system injury tied to specific substances: alcohol (hepatitis, cirrhosis, pancreatitis, cardiomyopathy, Wernicke encephalopathy, cerebellar degeneration); opioids (respiratory depression, overdose, constipation, infectious complications from injection); stimulants (hypertension, arrhythmia, stroke, myocardial infarction, psychosis); and injection-related infections (endocarditis, skin abscess, HIV, hepatitis C).
Withdrawal syndromes
Withdrawal is a medical condition with defined timelines. Alcohol and benzodiazepine withdrawal can be life-threatening (seizures, delirium tremens), typically peaking 24–72 hours after last drink; treat with benzodiazepines and thiamine before glucose. Opioid withdrawal is intensely uncomfortable but rarely fatal; treat with buprenorphine or methadone. Stimulant withdrawal is primarily dysphoria, fatigue, and hypersomnia.
Overdose and acute care
Opioid overdose: pinpoint pupils, respiratory depression, decreased consciousness - give naloxone, support airway, and observe for re-sedation because naloxone is shorter-acting than many opioids. Alcohol intoxication: assess for hypoglycemia, trauma, and co-ingestants; never assume intoxication explains altered mental status without evaluation.
Traps
Questions test the order of interventions (thiamine before glucose in at-risk patients), recognition that benzodiazepine and alcohol withdrawal require monitored settings in severe cases, and the fact that naloxone reversal may precipitate withdrawal and agitation.
Rule of thumb: for any intoxicated patient with altered mentation, treat the reversible causes and reassess - do not attribute all findings to the substance.