Medico legal aspects of “substance use disorders” among Egyptian patients admitted at The Institute of Psychiatry – Ain Shams University Hospitals

Abstract

Substance Use Disorders (SUDs) is a disease of mind that is associated with multiple co-morbidities as physical illnesses, psychiatric disturbances and criminality, in addition to the multiple morbidities as overdoses, relapses and cognitive impairment. Moreover, it affects different aspects of life as educational employment/functional, marital and social fields. Addiction is considered a medical disorder with legal implications; an addict is a very important medico-legal case. This work aims to study the medico-legal aspects of drug addiction among patients with SUDs regarding; 1. The Pattern of drug use among drug addicts admitted at The (IOP) - (ASU) Hospitals. 2. The magnitude of Legal consequences that appears to be as a result of drug addiction. A sample of 65 male patients admitted at the (SUDs) Unit–Institute of Psychiatry (IOP)–Ain Shams University (ASU) Hospitals fulfilling the criteria of the research were included in the study in the period from the first of July 2015 till the end of December 2015. In this study all participants were males; the majority of them were adults; 72.2% of patients were in the age group (25 - < 45 years), single (52.3%), living in urban areas (83.1%), stopped education at secondary school (47.7%), and unemployed (41.5%). All cases in this study were smokers and the majority (86%) started tobacco smoking in adolescence (>10 – < 20 years), the main substance of abuse among the majority of cases was I.V heroin in more than two thirds of the sample (69.2%). Most of them had initiated addiction in adolescence (72.3%). About 77% of cases started with cannabis mostly under peer influence then they progressed in their addiction disease process trying other substances mostly out of novelty seeking in 44.6% of cases until they became addicts on one of the hardest substances “heroin” using a very dangerous route of administration “I.V”. The majority of cases “60 patients out of the 65” (92.3%) tried to quit the substance many times before by various methods, and 70% of them succeeded in being abstinent for a while then relapsed on the substance again. Heroin addicts are more prone to quit the substance. Heroin addicts had the highest score at the medical domain in the Addiction Severity Index (ASI) in addition to the highest score of the final severity of addiction. Non-fatal overdoses constitute 78 incidents in about 49.2% of patients, while suicidal attempts involved only about 23% of patients but with an overall 40 trial to commit a suicide by different means, the most important of which is cut wrist in 12 incidents followed by heroin overdose in 9 incidents then tramadol overdose and