OnExam

Although most patients will be forthcoming with recreational drug use history, it can be important to have basic background on some of the more common or dangerous street drugs. An important, general question is to establish how a person uses drugs since this may influence their risk factors for other pathologies (e.g. intravenous vs snorted).

Quantities and Names

  • Marijuana
    • One gram of marijuana can make about three joints
    • Can also be inhaled via bongs, vaporizers, hookahs or eaten
  • Opiates/narcotics
    • Perks, Percocets, Oxy's, Oxycodone/Oxycocet
  • Cocaine
    • Snow, powder, blow
  • Methamphetamines
    • Speed, Meth, Blue
  • Huffing
    • The abuse of inhalants such as volatile solvents, aerosol sprays, gases, and nitrites
  • MDMA
    • Also known as ecstasy, X, XTC
    • Usually in tablet form but also consumed as crystalline powder

Expanded History

  • Withdrawal
    • Have you ever withdrawn, or had a withdrawal period
  • Safety
    • Have you ever shared needles, driven drunk, have unprotected sex while high
  • Intoxication
    • How much of substance A,B or C, does it take you to become intoxicated
  • Binge
    • Have you ever taken a large amount of substance A, B or C in one sitting

  • Social Supports
    • Do you have people in your life you can talk to or for support
  • Codependency
    • Have you had a previous, or do you have a ongoing mental health diagnosis
  • Suicide
    • Normalize, then ask, have you ever though of suicide
    • Are you thinking of suicide now?
    • Do you have a plan?
    • Have you ever attempted suicide in the past?

  • Function
    • Has taking substance A, B or C had an effect on your everyday life, work, etc
  • Depression/Anxiety
    • Are you feeling depressed, anxious
    • Do you have or have you had a previous diagnosis of depression or an anxiety disorder
    • Has not having or needing to acquire substance A, B or C ever caused you to feel depressed/anxious
  • Family/Friends Opinions
    • Have family or friends ever commented on your substance use
    • What were the comments like

References

  1. Bickley LS, Szilagyi, PG. The Health History. In: Bates’ Guide to Physical Examination and History Taking. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2007: 6-7.
  2. Goldbloom, D.S. Chapter 10 Assessing of Patients with Substance-Related Disorders. In: Psychiatric Clinical Skills. 2nd ed. Philadelphia, PA: Mosby Elsevier