Know and Go Friday, May 2016: Addiction Medicine
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Transcript of Know and Go Friday, May 2016: Addiction Medicine
Heroin/Pain Pill (Opioid) Addiction
Mary Kirkwood, MD, PsychiatristBoard Certified: Psychiatry &
Addiction MedicineAgnesian HealthCare
Heroin/Pain Pills = OpioidsWhat are Opioids?
Medication/substances that bind to the mu opioid receptor in the brain.
People experience less pain, but may also experience euphoria, sedation, nausea and impaired decision making. Too much opioid can cause
someone to stop breathing and die.Examples: hydrocodone (Vicodin),
oxycodone (Percocet), morphine, codeine, fentanyl, heroin
Symptoms of Opioid AddictionTolerance and withdrawalInability to cut down/control useMuch time spent using/obtaining/recovering
from opioidsStrong craving to use opioidsInability to attend to responsibilities at
school/work/homeUse in dangerous situations (driving)
Severity of Opioid AddictionMild: Two to three symptomsModerate: Four to five symptomsSevere: Six or more symptoms
Heroin/Pain Pill AddictionHow does it start?Complicated or multiple surgeries, or for chronic
pain syndromes. Others are offered pain pills at parties to get high.After using the pills on a chronic basis, patients
get ill from withdrawal when they don’t have pills.
Patients can’t function at work or with their families when they are so sick, so they look for pain pills wherever they can get them.
Heroin/Pain Pill AddictionPost Acute WithdrawalPsychological withdrawal symptoms
that last for up to two years, including irritability, anxiety, tiredness, poor concentration and disturbed sleep.
This makes quitting opiates/heroin very difficult. The temptation to take heroin/pain pills again to relieve these symptoms is hard to resist.
Why Heroin?Doctors are prescribing fewer pain pills because of addiction risk.
Pain pills are more expensive and harder to find in the community.
People in withdrawal are turning to heroin because it is cheaper and easier to find.
Heroin/Pain Pill Addiction
What is the best way to help?MedicationCounselingFamily/friend support
Heroin/Pain Pill AddictionMedication Assisted TreatmentOpioid Replacement = Suboxone and
MethadoneOpioids specifically designed to treat addiction to
help control withdrawal and cravings. Non-opioid replacement = Naltrexone
Helps with cravings, but not withdrawal. Lower success rate than suboxone/methadone.
Heroin/Pain Pill AddictionSuboxone versus MethadoneBoth eliminate withdrawalBoth control cravingsSuboxone: patients rarely develop tolerance Can be prescribed 30 days at a time
Methadone: tolerance is commonRequires daily dispensing at special clinic
Which Works Best?Both suboxone and methadone decrease risk of relapse.
Methadone has a slightly higher retention rate.
Naltrexone also decreases the risk of relapse, but more people drop out of treatment on naltrexone versus suboxone and methadone.
Which Is Safest?Methadone has a higher rate of lethal overdose than suboxone.
Suboxone is less likely to be injected.Naltrexone is the safest of all since there is no overdose risk.
Heroin/Pain Pill AddictionCounselingMedication alone is not enough. Individual
and group counseling help patients learn how to cope in everyday life without drugs.
Family SupportFamily/friends can help by understanding the
need for intensive treatment, which in most cases includes medication.
Pregnant PatientsThe most recommended treatment is suboxone or
methadone.On these medications, women have lower relapse
rates, attend more prenatal visits, and can provide a more stable home life for their baby.
Attempting to detox a woman completely from opioids increases the risk of miscarriage…suboxone and methadone decrease that risk.
OverdoseDeath is by respiratory failure - they stop
breathing.Between 2006 and 2011, there were no deaths
by suspected overdose in Fond du Lac.2012 = 1 death2013 = 4 deathsThe number one cause of accidental death in
the United States is due to poisonings/ overdoses (most commonly opiates).
2014 = 3 deaths2015 = 12 deaths
People Are DyingDeaths by opioid overdoses tripled from between 1999 and 2013.
Between 2010 and 2013 opioid pain pill deaths stabilized, but heroin opioid deaths increased by 37 percent per year.
Risk Factors for OverdoseOpioids plus sedatives and/or alcoholRecent abstinence: results in decreased tolerance
Use of illegal opioids, especially when injected
Lung disease/sleep apnea
What is Narcan?Narcan is a medication that rapidly reverses the effects of opioid overdose.
Comes in a shot form and a nasal spray.Communities that distribute Narcan have lower rates of death by opioid overdose.
Can be given by people in the community when an overdose is suspected.
Signs of an OverdoseThe person is non responsiveThe person isn’t breathing or doesn’t have a pulse
The person has a blue cast to lips or fingertips
Small pupils
Narcan to Prevent OverdoseWho is a candidate for a Narcan prescription?Anyone diagnosed with opioid addictionAnyone receiving or stopping medication
treatment with methadone or suboxoneAnyone at risk of decreased tolerance,
including people released from jail who have a history of opioid addiction
Family or friends of an individual with any of the above characteristics
Narcan AvailabilityAvailable by prescription as injection and nasal
spray at most pharmaciesAgnesian pharmacies have Narcan available by
prescription; hope to have over-the-counter soon
This Is a National EpidemicPresident Obama participated in the National
Rx Drug Abuse and Heroin Summit in Atlanta, GeorgiaIncrease the patient limit for doctors who prescribe
suboxone from 100 to 200Increase in funding
Underserved communities For the distribution of Narcan Investigate the distribution of pills/heroin Provide clean syringes to IV drug users to decrease
risk of HIV/hepatitis
Help at National LevelMedicare, Medicaid and Marketplace
insurance plans will be required to increase access to opioid addiction treatment.
The Center for Disease Control and Prevention has issued guidelines to primary care providers.
Black box warning for fast acting opioids, warning about the risks of abuse, addiction and overdose death.
Addiction Treatment at St. Agnes Hospital
Call (920) 926-4200 to schedule an addiction assessment.
Most patients attend our day treatment program, which lasts anywhere from two to five days, from 8 a.m. to 4 p.m.
During day treatment, most patients are started on suboxone and participate in groups on education about addiction and coping skills.
Addiction Treatment at St. Agnes Hospital, cont.
After day treatment, the patient participates in individual counseling, group counseling, and sees a psychiatrist for the suboxone.
Patients are encouraged to attend Narcotics Anonymous and get a sponsor.
Treatment with suboxone can last for as long as the patient needs it.
Patients successfully weaned from suboxone are encouraged to continue with Narcotics Anonymous (NA) and individual counseling.
Addiction Treatment at St. Agnes Hospital, cont.
Naltrexone (medicine that helps with cravings but isn’t an opiate) is also available to patients.
Treatment for depression, anxiety and other mental health issues.
ResourcesTo find information about opioid addiction
treatment outside of Agnesian HealthCare: http://www.methadoneclinicusa.com http://dpt2.samhsa.gov/treatment/directory.aspx
http://www.suboxone.com/treatment-plan/find-a-doctor
http://www.buprenorphine-doctors.com/find-a-doctor.cfm
Kellie
Before Addiction Childhood Loving family Good grades
High School New friends Experimentation Maintained good
grades
Progression of AddictionDesire to use kept increasing
Didn’t understand addiction
Hard to save moneyEmployment suffered to Use Kept
HeroinJustifications Cheaper Easiest to obtain It’s OK as long as I’m not shooting up like
a “junkie” Escalated quickly
Six Months Clean…Relapse
Rock Bottom Arrested June 8, 2014 Serious legal problems Facing possible prison
In jail I found out I was pregnant.
Recovery June 8, 2014 August 2014 - Treatment at St. Agnes
Hospital Behavioral Health Services Actively involved in Narcotics Anonymous
(NA)
Healthy Baby Girl – November 17, 2014
TodayLegal issues resolvedEmployed
Awesome Family Support
Healthy Friends
Sponsor
NARCOTICS ANONYMOUS
I’m Kellie.Recovering addict with 1 year and 11 months clean/sober.
My Life. . . . . . . . . . . . . . . . . . . . . .
Wendy McGurk
The BeginningMy father was an alcoholic
Thought everyone grew up around alcohol/normalHe was an angry drunk
My parents divorced when I was nine Felt very isolatedHad to move Started changing
My mother introduced new husband
AdolescenceStarted drinking at 14
First time I got wastedTried marijuana, cocaineNew group of friendsStopped caring about school and familyVery rebellious/started running awayBy 16, I was drinking every weekend and could
drink eight to 10 beers
Growing PainsBy 17, I had to sit in jail
First thoughts I might have a problemStraightened out, got it together and graduatedFound a job serving tablesAt 18 enrolled in college Struggled to get homework done due to drinkingDropped out after 1-½ years from alcohol use Still serving tables and drinking four to five nights a
week – 12 pack of beer
Stepfather DiesAt age 22, my stepfather died
Was introduced to opiates, painkillersBest feeling ever Was hooked right awayWas using regularly to numb painLost my jobLost my apartmentMoved back home
AddictionCould not stopObsession of the brain/all I thought aboutNobody trusted me anymoreWent from boyfriend to boyfriend to support habitStarted drinking when I did not have pills to avoid
withdrawal Tried to quit and failed Was using around 10 to 15 15mg Percocet dailyThought I was going to die/contemplating suicide
HealingSt. Agnes for help/inpatient programTotally surrendered and was willing to do
anything to get helpStarted suboxone programWithin the first week I felt changes
Obsessive thinking was goneHad clear thoughtsDid not want to take all of my medication Started therapy Gave my life over to the care of God
RecoveryIn the first year of sobriety I got married, had a baby and started school
I graduated from Moraine Park with high honors in December 2014 with my Associates Degree and SAC-IT
Bachelors from Viterbo end of 2016
RecoveryI now have a loving familyI have confidence in myselfI want to give what has been given to meBelieve that addiction is a disease that I need to manage daily
Life CAN change
Thank You!