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Heroin Oxys and The Highway to Hell PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Heroin, Oxys and The Highway to Hell" by Mark G. Fuller, MD CEO and Lisa Kugler, PsyD CEO, to learn about Opioids for professionals from multiple disciplines, information on heroin and opioids, the causes of addiction, treatment options and outcomes of treatment.

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Published on : Mar 14, 2023 | Views : 1476 | Downloads : 0

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“Heroin, Oxys and The Highway to Hell” Mental Health America June 2017 Mark G. Fuller MD CEO Lisa Kugler PsyD CEO
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Welcome and Introductions 2
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3 Goals Provide an introduction to Opioids for professionals from multiple disciplines Review background information on heroin and opioids Address the causes of addiction Discuss treatment options Overview outcomes
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4 This is where it starts: “Living easy, living free Season ticket on a one-way ride Asking nothing, leave me be Taking everything in my stride Don't need reason, don't need rhyme Ain't nothing I would rather do Going down, party time My friends are gonna be there too” Highway to Hell AC/DC
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5 This is where we end…
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6 Introduction to Opioids
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7 What are Opioids? Opioids: a type of pain medicine that is man made (oxycodone, Percocet) Opiates: a type of pain medicine that is naturally occurring (morphine, heroin)
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8 Where do Opioids Come From? All Naturally Occurring Opioids Come From the Opium Poppy…
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9 Where Does the Opium Poppy Come From? Three Primary Places Afghanistan The “Golden Triangle” Xalisco, Mexico (newer)
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10 Thought to produce 80 % of the world’s opium Recent estimate of $ 4 BILLION in export value Afghanistan
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11 “The Golden Triangle”
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12 Newer source of “Black Tar Heroin” Xalisco, Mexico “Dreamland” by Sam Quinones
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13 Processing of Opium into Heroin and Transport to Markets Worldwide What Happens Next? Map Courtesy of the CIA
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14 Opiates: naturally occurring Opium, Morphine, Heroin What are Some Examples?
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15 Manufactured by Bayer corporation in the late 1890’s for: Cough suppressant Pain relief Also: asthma, bronchitis, and tuberculosis Generic name: diacetylmorphine Heroin was the “Brand Name” German researchers noted people who took the drug said if may them feel “heroisch” or German for heroic. This is where the brand name came from Bayer stopped producing the drug in 1913 Great Britain still uses heroin and accounts for 95% of the world’s legal heroin use. Interesting Facts About Heroin
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16 Examples of Synthetic Opioids
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17 Medical Uses of Opioids Prescribed Indication: Important and essential medications for pain relief Other Uses: anesthesia, cough suppression, and diarrhea Toxic Effects: lethargy, respiratory depression, overdose, death
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18 Also known as “China White” Powerful synthetic pain medicine (50 – 100 x more than morphine) Used to treat severe pain often related to surgery Available as an injection, patch or lozenges Clandestine laboratories are playing a bigger role in the epidemic Why is it dangerous? Uncertain purity; can be very potent Can cause breathing to stop and result in death Often added to poor quality heroin or sold as oxycontin What is Fentanyl ? NIDA 2016
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19 Potent animal tranquilizer (large animals such as elephants) NOT APPROVED FOR USE IN HUMANS First synthesized in a lab in 1974. Brand name Wildnil One of the most powerful opioids available (10,000 x more than morphine and 100 x more than Fentanyl) Linked to a significant number of overdose deaths across the country Clandestine labs are mixing it with heroin and other street drugs Often manufactured in China and imported to the US Update on Carfentanil NIDA 2016
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20 So How Did We Get from Medical Treatment to Abuse and Dependence with Opioids?
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21 Why Do Some Drugs Lead to Abuse/Dependence? Because of their effect on the brain Many drugs have no abuse potential Examples include aspirin, antibiotics and high blood pressure medicine Others can lead to abuse and dependence including opioids and sedatives (like benzodiazepines)
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22 What Happens in the Brain that can Lead to Addiction?
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23 Let’s Start With, How Do Opioids Work in the Brain?
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Basic Model of Nerve Cell Communication
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25 Endorphins and Opioids in the Brain First discovered in 1970’s The brain has both receptors for opioids and it makes its own opioids Called Endorphins What do they do? How does this figure into addiction?
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Endorphins and Opioid Receptors Heroin
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What Happens to Endorphins in Heroin Users Over Time? Changes in Brain Chemistry 27
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Heroin The Longer Heroin (or other opioids) are Present, the Less Need there is for the Brain to Make (and release) Endorphins
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Heroin Until Eventually…..
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Think of a Thermostat and a Space Heater 30
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31 Chronic pain was identified by many medical groups as undertreated in the 1990s Numerous medical societies endorsed the increased use of pain medication including: American Academy of Pain Medicine American Pain Society American Geriatric Society The Pain Society The Role of Chronic Pain and Opioid Prescribing
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32 One Commonly Cited Statistic
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33 Oxycodone hydrochloride controlled-release Sustained release form of oxycodone Very powerful slow release pain killer Approved by FDA in 1995 Marketed as “non-addictive” Street name “Oxys” A Few Words about OxyContin
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34
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35 1.9 million Americans live with prescription opioid abuse or dependence Opioid Addiction occurs in every state, every county and every socio-economic and ethnic group in the US Over 100 people in the US die from overdose deaths each day. Half of these are from prescription opioids (this works out to 2 every hour) Facts on Opioid Addiction American Society on Addiction Medicine
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36 In 2012, 259 million opioid pain medication prescriptions were written Enough for every adult in America to have their own bottle of pills 75% of prescription opioid-dependent individuals switch to heroin because it is cheaper More Facts on Opioid Addiction American Society on Addiction Medicine
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37 Every day, 2500 American youth (12-17) abuse a prescription pain pill for the first time Nearly 1 in 20 high school students has taken Vicodin 1 in 30 have taken Oxycontin Most of them got their pills from a friend or relative The number of opioids prescribed to young adults (15-29) doubled between 1994 and 2007 Teens and Opioids American Society on Addiction Medicine
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38 Prescription opioid overdoses killed 5 times as many women in 2010 than in 1999 More than 6600 women died from prescription opioid overdoses in 2010 (18 per day) Every 3 minutes, a woman goes to an ED for prescription opioid abuse (or misuse) Women and Prescription Opioids American Society on Addiction Medicine
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48 Stigma and Drug Addiction The stigma associated with drug addiction keeps many people from entering treatment Typical thoughts about “drug addict” Poor, undesirable, anti-social, “low-life”, etc. Next slides contain some examples of real life “drug addicts”
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50 Prince (1958 – 2016)
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52 Cory Monteith
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53 It affects people from all walks of life It affects people from all age groups It affects people from all races and religions There is no “typical drug addict” Key Aspect of Treatment: de-stigmatize addiction and get people into treatment! The Truth about Drug Addiction
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54 Yes! Addiction is a treatable disease. Research in the science of addiction and the treatment of substance use disorders has led to the development of evidence-based interventions that help people stop abusing drugs and resume productive lives. Can Addiction be Treated?
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55 Treatment works best when it involves the whole person This can also include the entirety of the system of which the person belongs Treatment
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56 Cognitive Behavioral Motivational Interviewing Contingency Management Kinds of Treatment
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57 Drug Free Treatment The Importance of Treatment Matching ASAM Patient Placement Criteria Medication Assisted Treatment Methadone Suboxone Vivitrol and ReVia Treatment for Opioid Addiction Treatment Works!
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58 Does Treatment Really Work?
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59 What is Recovery? The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental disorders and substance use disorders as, “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” Treatment Outcomes
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60 Recovery is a Continuum
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61 Physician Health Program (PHP) care management requires abstinence conditions (for alcohol and all non-prescribed drugs), intensive and sustained monitoring and deterrence through swift, certain, and meaningful consequences for non-compliance. The long-term recovery rates for physicians are between 70 and 96 percent which is the highest in all of the treatment outcome literature. A longitudinal cohort study of 904 physicians admitted to 16 PHPs used outcome measures of program completion, continued abstinence of alcohol and other drug use, and continued occupation after five years Outcomes Vary
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62 Participants in Hawaii’s Opportunity Probation with Enforcement (HOPE) have significant documented substance use problems and are at high risk for violating probation. In HOPE, offenders are subject to frequent random drug and alcohol testing for up to five years. A missed test or a positive drug test is met with an immediate short-term jail stay. Formal addiction treatment is available to offenders who request it and to those who demonstrate the need for treatment by repeated non-compliance and relapse to drug use. A randomized controlled evaluation found that after one year in the program, compared to offenders on standard probation, HOPE participants were 72 percent less likely to use drugs and 55 percent less likely to be arrested for a new crime Outcomes Vary
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63 How Many People Relapse from Addiction?
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64 Be alert for signs of addiction on all health care settings Be ready to ask about drug use and have a discussion about it Make referrals to drug treatment professionals Don’t be judgmental Be optimistic and reassuring Reduce stigma by talking about it What Can Other Health Professionals Do?
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65 Learn about substance use… it is NOT those others Out of my management team, 2 of the 12 have lost a first degree relative in the last 2 months to substance abuse There is an app for that…. Bridges to Sobriety (App) Missouri Institute of Mental Health What Can Other Health Professional Do?
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66 Think Influenza, Ebola, West Nile Virus Same principles These are not being implemented very effectively due to a lack of recognition of this epidemic and the stigma against individuals with drug addiction How Do You Break an Epidemic?
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67 Primary Prevention: prevent new cases of opioid dependence. Education, outreach, community prevention programs, etc. Secondary Prevention: provide interventions and ready access to treatment Tertiary Prevention or Supply Control: law enforcement and medical board interventions to reduce over-prescribing and black-market availability. Relapse prevention to keep individuals from returning to active addiction Breaking an Epidemic: A 3 Pronged Approach
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68 The best selling book about the real story behind the American Opioid Epidemic By Sam Quinones Available on Amazon Other Resources
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69 The poem that was read at the beginning was taken from the most recent Pennsylvania’s Coroner’s report. The poem was shared by a mother on the loss of her daughter with Dauphin County Coroner Graham Hetrick. The mother had asked that the poem be shared in hopes that its reality can help prevent other mothers, fathers, brothers and sisters from having to share in the devastation of the loss of a child. “She was a good student, a good kid that most likely went down this path of first abusing prescription drugs and then finally using heroin. She tried to escape the lure of opiates but wasn’t strong enough. Just a week or two before her death she wrote this poem to her younger sister, warning her about the dangers of drug abuse." January 31, 2014 And now…the rest of the story
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70 Questions and Discussion?
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71 Center for Substance Abuse Treatment, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol Series 43. HHS Publication No. (SMA) 08-4214. SAMHSA Center for Substance Abuse Treatment, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addcition. Treatment Improvement Protocol Series 40. HHS Publication No. (SMA) 07-3939. SAMHSA Federal Guidelines for Opioid Treatment Programs. HHS Publication No. (SMA) PEP 15-FEDGUIDEOTP. SAMHSA Principles of Drug Addiction Treatment: A Research-Based Guide. NIH Publication No. 12-4180. National Institutes of Health. Substance Abuse and Mental Health Services Administration (SAMHSA), www.samhsa.gov References
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72 Kolodny A. “The Opioid Analgesic Epidemic: How it Happened.” National Summit on Opioid Safety, Group Health Cooperative; 1NOV12. Physicians for Responsible Opioid Prescribing. www.supportprop.org Substance Abuse and Mental Health Services Administration (SAMHSA), www.samhsa.gov American Society of Addiction Medicine (ASAM); www.asam.org Quinones S. “Dreamland: The True Tale of America’s Opioid Epidemic”; Bloomsbury Press. April 2015. A Flood of Opioids, a Rising Tide of Deaths. Okie S. New England Journal of Medicine, Volume 363. No. 21, Pages 1981-1985. November 2, 2015. Principles of Addiction Medicine. Ries R, ed. The American Society of Addiction Medicine. 2014 References Part 2
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73 Mark G. Fuller, MD Mark.Fuller@beaconhealthoptions.com Lisa Kugler, PsyD Lisa.Kugler@beaconhealthoptions.com Presenters
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74 Thank You!