Download Street Drug Guide

Street Drug Guide
Virtual Patient Instructor Guide
www.chec-cesc.ca/addiction
Case created by:
Sonya Lee, Sandra Morrison, Cathlin Mutch, David Topps, Heather Armson, Carly
Glasner, Janet Corral, Chris Diamant, Lori Montgomery,
University of Calgary
This Instructor’s guide and the corresponding virtual patient case are made available by the
Association of Faculties of Medicine of Canada as part of a suite of resources on Addictions
e-Learning for Undergraduate Medical Education. The suite includes a series of virtual
patient cases, podcasts and an e-textbook on addiction. The resources are available under
a Creative Commons license, Attribution-NonCommerical-ShareAlike 3.0 and available at
www.CHEC-CESC.ca/addiction.
Sponsored by:
Developed by:
AFMC Addiction e-Learning for Undergraduate Medical Education
www.chec-cesc.ca/addiction
Table of Contents
Outline of the case ........................................................................................................................................ 2
Learning objectives ....................................................................................................................................... 3
Professional Objectives and Competencies .................................................................................................. 3
Medical Council of Canada........................................................................................................................ 3
The CanMEDS Physician Competency Framework ................................................................................... 3
How to use the case ...................................................................................................................................... 4
Post-game discussions/activities .................................................................................................................. 4
Additional reflective questions ..................................................................................................................... 4
Evaluation form for participants ................................................................................................................... 4
Background Material..................................................................................................................................... 4
e-Textbook Primer .................................................................................................................................... 4
Podcast ...................................................................................................................................................... 5
Author Information & Credits ....................................................................................................................... 5
Have you completed the cases? ................................................................................................................... 5
Checklist .................................................................................................................................................... 5
Virtual Patient Instructor Guide
Page 1
AFMC Addiction e-Learning for Undergraduate Medical Education
www.chec-cesc.ca/addiction
Outline of the case
‘Street Drug Guide’, http://vp.openlabyrinth.ca/renderLabyrinth/index/37
The Street Drug Guide was designed to be used on mobile devices. It is partly a reference aid so that you
can look up information about drug culture on the street that is difficult to find elsewhere and has a lot
of ancillary material linked within it.
There is also a series of mini-cases highlighting some tricky aspects of managing patients with substance
addiction problems. As the learner moves through the cases, the pertinent facts of the case are
revealed. The learner will be required to engage general principles of history taking, consider principles
of reflective practice, use several risk scoring tools, and is challenged to bring a complete perspective to
the care and treatment of a patient with addiction. These cases are much shorter, typically taking only 510 minutes, so can be played during down time between real cases.
With regards to addiction and mental health, the case will expose the learner to conditions related to
adverse childhood experiences. The learner will encounter stigma associated with conditions related to
addiction and concurring mental health issues and will reveal strategies for reflective practice. They will
learn about developing a plan of care that a) meets the immediate needs of a patient in the clinic
setting, b) is appropriate for a patient with addiction, c) is cognizant of early childhood influences, and d)
is integrated into a continuing-care strategy for the management of addiction.
Audience
Type of Case
Duration to
complete the case
Curriculum
Connections
Technical
requirements
Medical students, nurses, paramedics, residents
This reference is designed to be used for individual self-directed learning or as a
quick reference resource when going to see a real case
 Self-directed learning: 5 - 10 minutes per case or 45 minutes total
Addiction medicine, family medicine
Internet connection plus standards-compatible web browser (not Internet
Explorer, versions 6-8)
Link: http://vp.openlabyrinth.ca/renderLabyrinth/index/37
Most mobile devices will be able to play these cases
Optional:
Educators and learners are welcome to create new versions of the case to meet
the learning needs of their program under a Creative Commons License Attribution, Non-Commercial, ShareAlike. The Instructions and software
requirements for modifying the case are included below.
On your local server:
 Install OpenLabyrinth v3.0 or later http://openlabyrinth.ca (free software)
 Import the case
 This VP case is provided as a Medbiq/ANSI compliant self-contained Zip file.
Simply import this case into your OpenLabyrinth server and it is ready to run
Virtual Patient Instructor Guide
Page 2
AFMC Addiction e-Learning for Undergraduate Medical Education
www.chec-cesc.ca/addiction
Learning objectives
By the end of this virtual patient case the learner should be able to:
a. Learn how to interact with drug seeking patients who may be less open about their
behaviours
b. Recognize substance abuse as a common complication of a clinic visit, in terms of effects
on diagnoses, therapeutic management and follow-up planning.
c. Understand that individuals diagnosed with addictions often have a past that includes
traumatic experiences
d. Understand exposure to traumatic events before the age of 18 increases the likelihood
of physical and mental health problems, including addiction.
e. Screen for adverse childhood experiences
f. Describe effective treatment strategies for people struggling with the emotional effects
of toxic stress exposure
g. Screen for family, social and childhood issues around substance abuse
Professional Objectives and Competencies
Medical Council of Canada
Medical Council of Canada (MCC) Objectives for the Qualifying Examination (excerpt):
103 ADDICTIONS/SUBSTANCE ABUSE Rationale: Addiction may be to substances or may be a process
(behavioral) addiction. Alcohol and nicotine abuse are such common conditions that virtually every
clinician is confronted with their complications. Addiction to prescription drugs and to other substances
is prevalent in all communities and is a common cause of medical morbidity and mortality. Causal
conditions: 1. Substance use: a. Stimulants, b. Depressants, c. Other substance; 2. Process (behavioral)
addictions (e.g., gambling); 3. Adverse childhood or traumatic experiences; 4. Epigenetic changes Key
objectives: Given a patient with an addiction or a substance abuse problem, the candidate will be able
to identify the issue, potential consequences and the need to provide immediate and continuing support
and intervention. (Source: MCC Objectives for the Qualifying Examination: 103 Addictions/Substance
Abuse)
Other relevant objectives:
 103-1 Substance Withdrawal
 59-1 Mood disorder
 78-4 Administration of Effective Health Programs at the Population Level: Population Health
The CanMEDS Physician Competency Framework

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Health Advocate
Communicator
Virtual Patient Instructor Guide
Page 3
AFMC Addiction e-Learning for Undergraduate Medical Education
www.chec-cesc.ca/addiction
How to use the case


This case has been designed to encourage self-directed learning but can also be used as a reference
point. Students will require access to a web browser.
The case can also be used in a flipped-thinking approach: have the students try the case before class
and then discuss their outcomes and approaches during small group work.
Post-game discussions/activities
Reflective questions are built into the case but group discussion and debriefing is encouraged at the end
of each section, as well as at the end of the case.
Additional reflective questions
Listen to the Early Trauma in Addiction, (Audio Only, Video, Study Guide)
Are you aware that treatment options that include trauma informed intervention services can lead to
positive outcomes for those exposed to early toxic stress?


Identify several trauma informed services identified in the podcast.
How could these services support Polly?
Evaluation form for participants
The validated eViP Student Questionnaire is a recommended model template
Background Material
Opioid Risk Tool
Opioid Treatment Agreement
Triplicate Prescription Program

FP Notebook for depression criteria.
e-Textbook Primer
1. J. Cameron, The effects of stress on brain development, AFMC Primer on the Biopsychosocial
Approach to Addiction, http://addictionprimertest.afmc.ca/Section1-Basic-and-SocialScience/Biopsychological-Factors-In-Addiction/Adverse-childhood-experiences
2. R. Lanius & M Tursich, Adverse Childhood Experiences, AFMC Primer on the Biopsychosocial
Approach to Addiction, http://addictionprimertest.afmc.ca/Section1-Basic-and-SocialScience/Biopsychological-Factors-In-Addiction/Adverse-childhood-experiences
Virtual Patient Instructor Guide
Page 4
AFMC Addiction e-Learning for Undergraduate Medical Education
www.chec-cesc.ca/addiction
3. S. Lee & D. Topps , History Screening and Detection, AFMC Primer on the Biopsychosocial
Approach to Addiction, http://addictionprimertest.afmc.ca/Section1-Basic-and-SocialScience/Biopsychological-Factors-In-Addiction/Adverse-childhood-experiences
4. Full list of ACE Study publications can be found at the ACE Study Website, Adverse Childhood
Experiences (ACE) Study, United States Centers for Disease Control and Prevention,
http://www.cdc.gov/ace/index.htm
5. ACE Score Calculator - English, The Adverse Childhood Experience Study,
http://acestudy.org/ace_score
Podcast
Early Trauma in Addiction, AFMC Early Brain and Biological Development and Addiction, UME Podcast
Series, (Audio Only, Video, Study Guide)
Author Information & Credits
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Sonya Lee, Assistant Professor, Family Medicine, University of Calgary
Sandra Morrison, Clinical Associate Professor, Family Medicine, University of Calgary
Cathlin Mutch, Resident, Family Medicine, University of Calgary
David Topps, Professor, Family Medicine, University of Calgary
Heather Armson, Associate Professor, Family Medicine, University of Calgary
Carly Glasner, Family Physician, Vancouver
Lori Montgomery, Clinical Lecturer, Family Medicine, University of Calgary
Have you completed the cases?
Checklist
Section one: Mini-cases
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Adam
o ☐Delirium – cause?
☐Alice – student in trouble
☐Ann – deteriorating mind
☐Beth – prenatal issues
☐Bruce – anger and substances
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☐Joan – worried re son
☐Vince – vomiting cause?
☐Pick a case at random
☐Explore benzodiazepine misuse
Section two: Reference options
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☐ Street Guide Notebook
o can be annotated with local information
☐ Local Survival Guide
Virtual Patient Instructor Guide
Page 5
AFMC Addiction e-Learning for Undergraduate Medical Education
o
www.chec-cesc.ca/addiction
annotatable info about street life
Virtual Patient Instructor Guide
Page 6