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Episode of harmful substance use — Clinical Guidelines

Overview

An episode of harmful substance use refers to the misuse or overdose of substances, including pharmaceuticals like paracetamol, which can lead to severe health consequences ranging from acute toxicity to fatal outcomes. Proper assessment and management are critical to mitigate risks and improve patient outcomes 7 11.

Diagnosis

Clinical Presentation: Symptoms vary based on substance type and dose, including but not limited to nausea, vomiting, abdominal pain, confusion, and in severe cases, organ failure 7.

Recommended Tests: Blood levels for specific substances (e.g., paracetamol levels for overdose) and liver function tests to assess organ damage 2 7.

Triage Guidelines: Out-of-hospital assessment tools for paracetamol exposure updated for current trends and healthcare system changes 2.

Management

First-Line Treatments:

- Paracetamol Overdose: N-acetylcysteine (NAC) administration as soon as possible, with dosing adjusted based on time since ingestion 2 7. - General Supportive Care: Monitoring vital signs, airway management, and supportive measures for organ function 7.

Adjunctive Treatments:

- Specific Medications: For severe cases, consider additional therapies like liver transplantation if indicated 7. - Psychosocial Support: Integration of mental health services to address underlying substance misuse 6.

Special Populations

Elderly: Higher risk of inappropriate prescribing and adverse drug events; careful medication review and adherence to Beers criteria recommended 8 12.

Home Health Care Patients: Prevalence of potentially inappropriate medications (PIMs) is high; enhanced medication reconciliation services are crucial 11.

Key Recommendations

Prompt Administration of N-Acetylcysteine for Paracetamol Overdose: Initiate NAC therapy as soon as possible after suspected overdose to prevent liver damage (Evidence: Strong 2 7).

Implement Enhanced Medication Review in Elderly Patients: Utilize tools like the Beers criteria to reduce inappropriate prescribing and adverse drug events (Evidence: Moderate 8 12).

Improve Adverse Event Reporting Systems: Advocate for more rigorous reporting standards to enhance data quality and reduce false safety signals (Evidence: Expert opinion 1).

Increase Training on Prescription Drug Safety in Workplaces: Employers should offer more comprehensive training on the safe use and monitoring of prescription drugs (Evidence: Expert opinion 6).

References

1 Khouri C, Hlavaty A, Fusaroli M, Joshi N, Salvo F, Bate A et al.. The Rising Misuse of Pharmacovigilance Reporting Systems: A Threat to Evidence-Based Medicine. Clinical pharmacology and therapeutics 2026. link 2 Fox EJ, Dalton AM, Mullins ME, Matoushek T, Ruha AM, Burns MM et al.. Out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure in the United States and Canada: a consensus guideline. Clinical toxicology (Philadelphia, Pa.) 2025. link 3 Morgan T. Analysts Go Live: 15 Years With . Psychoanalytic review 2025. link 4 Tchijevitch OA, Nielsen LP, Lisby M. Life-Threatening and Fatal Adverse Drug Events in a Danish University Hospital. Journal of patient safety 2021. link 5 Madiraju C, Tellez-Corrales E, Hua H, Stec J, Nauli AM, Brown DM. Analysis of Student Perceptions of Just-In-Time Teaching Pedagogy in PharmD Microbiology and Immunology Courses. Frontiers in immunology 2020. link 6 Kohanna F. What You Need to Know About Prescription Painkillers and Safety Risks. Occupational health & safety (Waco, Tex.) 2016. link 7 Skinner A. Paracetamol overdose. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2015. link 8 Cahir C, Fahey T, Teljeur C, Bennett K. Prescriber variation in potentially inappropriate prescribing in older populations in Ireland. BMC family practice 2014. link 9 Albano CB, Brown W. Integration of physical assessment within a pathophysiology course for pharmacy. American journal of pharmaceutical education 2012. link 10 Gregson KS, Romito LM. Using the patient's medication history as a learning tool in clinical pharmacology instruction for dental students. Journal of dental education 2012. link 11 Bao Y, Shao H, Bishop TF, Schackman BR, Bruce ML. Inappropriate medication in a national sample of US elderly patients receiving home health care. Journal of general internal medicine 2012. link 12 Lund BC, Steinman MA, Chrischilles EA, Kaboli PJ. Beers criteria as a proxy for inappropriate prescribing of other medications among older adults. The Annals of pharmacotherapy 2011. link 13 Woodard LJ, Wilson JS, Blankenship J, Quock RM, Lindsey M, Kinsler JJ. An elective course to engage student pharmacists in elementary school science education. American journal of pharmaceutical education 2011. link 14 Moumtzoglou A. Reporting adverse events: Greek doctor and nurse attitudes. International journal of health care quality assurance 2010. link 15 Cox AR, Butt TF, Ferner RE. An analysis and comparison of commonly available United Kingdom prescribing resources. Journal of clinical pharmacy and therapeutics 2010. link 16 D'Arcy Y, Johann D. Using a medication protocol to improve pain management. Nursing management 2008. link 17 . ACOG Committee Opinion. Safe use of medication. Number 331, April 2006. Obstetrics and gynecology 2006. link 18 Wells JL, Borrie MJ, Crilly R, Brymer CD, Hurwitz JS. A novel clinical pharmacy experience for third-year medical students. The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique 2002. link

Episode of harmful substance use