Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of...
Transcript of Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of...
![Page 1: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/1.jpg)
Opioid Epidemic:A Hopeful Roadmap for the
FutureDr. Ritu Bhatnagar, M.D., M.P.H.
Addiction PsychiatristApril 13, 2019
![Page 2: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/2.jpg)
Disclosure statementNo conflicts of interest with this presentation.Financial Interests: portion of investment portfolio may have
stock in publicly traded pharmaceutical companies.
![Page 3: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/3.jpg)
An Epidemic of New Proportions
From https://www.nytimes.com/interactive/2018/11/29/upshot/fentanyl-drug-overdose-deaths.html
![Page 4: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/4.jpg)
Response?
![Page 5: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/5.jpg)
![Page 6: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/6.jpg)
How to make sense of the information?
“These trends are a wake-up call to a national well-being crisis.”
-- Trust For America’s Health National Resilience Strategy. https://www.tfah.org/report-details/pain-in-the-nation/
![Page 7: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/7.jpg)
“It is better to light a candle than to curse the darkness.” -- Eleanor Roosevelt
![Page 8: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/8.jpg)
The Science of Addiction
![Page 9: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/9.jpg)
What is addiction?
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”
Characterized by:Needing more of a substance to get same effectWithdrawal symptoms when substance is not availableCravings and urges for substance that interfere with social function
Involves the biology, psychology, social and spiritual aspects of a person.http://www.asam.org/quality-practice/definition-of-addiction
![Page 10: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/10.jpg)
So, is Addiction a Disease?
From “Pleasure Unwoven”, Documentary with Dr. Kevin McCauley
![Page 11: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/11.jpg)
From https://www.youtube.com/watch?v=h9ZzmoiRxSQ “Neurobiology of Addiction”
![Page 12: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/12.jpg)
Comparing
DiabetesGenetic influencesExposure to sugarChange in pancreasBehaviors impact disease stateTreatment exists Accessible treatmentMinimal judgment
AddictionGenetic influencesExposure to substanceChange in brainBehaviors impact disease stateTreatment exists Less accessible treatmentLots of stigma
![Page 13: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/13.jpg)
My clinical work
![Page 14: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/14.jpg)
Practice of Medicine
Socio-economic Forces
Opioids
![Page 15: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/15.jpg)
.1 Relevant history
The future
The year 2000
The ‘80s and ‘90s
2010 to present day
2
3
4
5
6
The early 2000s
1
![Page 16: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/16.jpg)
Relevant History.1 Relevant
history
![Page 17: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/17.jpg)
1620 Opium smoking
1806 Morphine isolated
1853 Syringe developed
1874 Heroin first synthesized in London
![Page 18: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/18.jpg)
1898 Bayer marketed heroin as a “non-addictive morphine substitute and cough suppressant”
1910 Young working-class Americans learned to inhale heroin for a concentrated high
1924 US Congress banned sale, importation, or manufacture of heroin
1935 Narcotic Farm in Lexington, KY
![Page 19: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/19.jpg)
Forces influencing the First Opioid EpidemicIndustrial revolution consequences: loss of jobs, economic insecurity
Physicians and pharmacists helped bring prescribing under control
U.S. came through it by creating a social safety net that provided a reset
The New Deal provided jobs, education, training, opportunities and hope for the public
![Page 20: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/20.jpg)
Narcotic Addiction Treatment Act (1974)Narcotic: a drug or other substance affecting mood or behavior and sold for nonmedical purposes, especially an illegal one. Today, refers mostly to opioids.
NATA regulated the treatment of opioid addiction with methadone.
It created the daily dosing clinics.
Dosing, treatment and prescription tightly regulated.
Created its own stigma.
![Page 21: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/21.jpg)
1980s and 1990s
![Page 22: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/22.jpg)
War on Drugs
![Page 23: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/23.jpg)
Social and economic changesCommercialization- Sackler drug advertising campaigns
Direct to consumer marketing:
Ability of corporations to push products without health and safety oversight
Led to increased influence of corporations on social norms
Changed cultural norms and social values
![Page 24: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/24.jpg)
1900-1920s advertising
https://www.smithsonianmag.com/science-nature/how-advertising-shaped-first-opioid-epidemic-180968444/
![Page 25: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/25.jpg)
1990s+ ad campaigns
![Page 26: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/26.jpg)
Why the focus on pain?Editorial in NEJM in 1980 made the claim that only 4 of 12,000 patients treated with opioids in a hospital became addicted.
“We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.” -- Portenoy and Foley, Pain, 1986: 25: 2: 171-186.
In the early 1990s, American Pain Society declared a national epidemic of untreated pain in hospitals.
![Page 27: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/27.jpg)
A slippery slope“Opioids [such as Oxycontin] are not addictive” message marketed heavily to physicians.
The Joint Commission, federal agency that regulates the practice of medicine, mandates that pain be measured and treated.
Pain became the 5th Vital sign.
![Page 28: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/28.jpg)
![Page 29: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/29.jpg)
The Fifth Vital Sign
“The misguided acceptance of pain as the fifth vital sign has been, and still is, the single biggest mistake in the history of modern medical pain management.” -- Dr. Myles Gart, Medical Economics, May 2017
![Page 30: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/30.jpg)
Opioid Prescribing & Opioid-Related Harm
National Vital Statistics System, 1999-2008; Automation of Reports and Consolidated Orders System; Treatment Episode Data Set
![Page 31: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/31.jpg)
Where do People get their Opioids?
SAMHSA. (2017). Results from the 2016 National Survey on Drug Use and Health
![Page 32: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/32.jpg)
The Year
![Page 33: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/33.jpg)
Drug Addiction Treatment Act: Congress ActsAllowed prescription of medication to treat opioid addiction from the primary care doctor’s office
Additional training to get the DATA waiver to prescribe buprenorphine
BIG change from NATA of 1974 allowing only daily dosing clinics to dispense methadone for the treatment of addiction.
Buprenorphine, relatively new medication, billed as less likely to be abused, and more difficult to overdose.
![Page 34: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/34.jpg)
From ACOPC Summer Conference 2016 slides and product websites.
![Page 35: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/35.jpg)
The Early 2000s
![Page 36: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/36.jpg)
The internetSo much potential for sharing information and perspectives
Has been shown to be isolating in the way many Americans are using it for social media, leading to increased rates of depression, inadequacy, lack of connection and perspective.
![Page 37: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/37.jpg)
![Page 38: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/38.jpg)
![Page 39: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/39.jpg)
![Page 40: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/40.jpg)
Happiness vs. PleasureHappiness: a state of well-being and contentment
Pleasure: a state of gratification (Merriam Webster)
![Page 41: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/41.jpg)
The search for happiness?
![Page 42: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/42.jpg)
Reasons for Prescription Opioid Misuse
SAMHSA. (2017). 2016 NSDUH.
![Page 43: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/43.jpg)
2010- present
![Page 44: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/44.jpg)
Opioid Overdose & Prescribing Trends
CDC 2018, Pezalla et al. 2017.
![Page 45: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/45.jpg)
Social pressures
“Many factors contribute ... including family and social relationships, social-emotional development, early childhood trauma and lack of economic opportunity, poor working conditions and eroded social capital in depressed communities...”
-- Trust For America’s Health National Resilience Strategy. 2018. https://www.tfah.org/report-details/pain-in-the-nation/
![Page 46: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/46.jpg)
![Page 47: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/47.jpg)
![Page 48: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/48.jpg)
![Page 49: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/49.jpg)
Multi-layered epidemic in 3 waves
![Page 50: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/50.jpg)
https://www.vivitrol.com/opioid-dependence/about-addiction-and-treatment
![Page 51: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/51.jpg)
Advances in neuroscienceNeuroplasticity: ability of brain to alter the strength of connections among neurons, effectively re-wiring them and create entirely new pathways.
Brain is resilient:
Neuroplasticity occurs through life cycle!
Treatment CAN be effective
![Page 52: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/52.jpg)
Epigenetics“Changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.”
Individuals respond to their unique environment based on individual genotype.
Gene by environment interactions.
Can occur in both positive and negative directions.
![Page 53: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/53.jpg)
What we are doing that is working
![Page 54: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/54.jpg)
![Page 55: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/55.jpg)
To effect supply and demandAcademic detailing of physicians to counter marketing from drug companies
Regulation, opioid prescribing guidelines
Education of people about dangers of opioid use, alone and with other substances
![Page 56: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/56.jpg)
To increase treatment Education of providers, medical students, residents about addiction
Peer Recovery Coaches
Law enforcement and mental health partnerships to access treatment- drug court diversion programs
Talking about addiction as a disease
![Page 57: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/57.jpg)
Harm reduction works!
![Page 58: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/58.jpg)
Reducing Stigma campaigns
![Page 59: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/59.jpg)
Treatment lessonsNeed fewer barriers to access treatment: ACA, Medicaid expansion
Treatment needs to be individualized, and timely
Treatment needs to be available at the time of discharge from jail, institutional settings
Treatment works best when physicians and patients decide how long a medication and therapy are continued.
![Page 60: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/60.jpg)
From https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
![Page 61: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/61.jpg)
November 25, 2018
![Page 62: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/62.jpg)
Opposite of Addiction:
ConnectionImage from https://www.huna.org/html/hcircle.html
![Page 63: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/63.jpg)
![Page 64: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/64.jpg)
Future Opportunities
![Page 65: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/65.jpg)
Clinical changes already happening!
Clinical guidelines that specify limited indications for prescribing opioidsEvidence based alternatives to treat painChange measurement of pain from a number to functionPDMP for all prescribers, including dentists
![Page 66: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/66.jpg)
Opportunities“We need a comprehensive National Resilience Strategy that focuses on prevention, early identification of issues and effective treatment.”
Individual
Family
City and State
Federal
Trust For America’s Health National Resilience Strategy. 2018. https://www.tfah.org/report-details/pain-in-the-nation/
![Page 67: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/67.jpg)
IndividualBe aware of the difference between happiness and pleasure
Find ways to calm yourself that are healthy and connect you to things you find meaningful
Question advertising messages
Explore resources like www.storyofstuff.com; Campaign for Commercial Free Childhood
![Page 68: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/68.jpg)
IndividualKeep your medications safe and accountable
Learn how to use Narcan- no prescription required in Wisconsin
Allow yourself to get help if you need it- there are resources available
Be realistic about expectations of pain management
Look for multi-modal ways to relieve pain
Try being non-judgmental
![Page 69: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/69.jpg)
From https://www.originsrecovery.com/together-can-fight-powerful-stigma-addiction/
![Page 70: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/70.jpg)
FamilyFocus on the impact on children and need for multi-generational approach
Eat dinner together as much as you can
Talk to each other about things that matter to you
Let the kids in your life know how you feel about substance use early.
Talk about family history of substance use so kids know their risk factors
Help kids thrive without as much media in their lives (yes, this takes more of your time)
Celebrate holidays with time together rather than things
![Page 71: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/71.jpg)
City and State: increase community resilienceHelp community be more connected
Invest in early childhood programs
Support children’s education and access to mental health care at all grade levels
Remove silos of care, encourage sharing treatment opportunities
Support different treatment approaches- therapeutic communities, treatment and employment support in one place
Expand life-skills training in areas that are economically distressed
![Page 72: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/72.jpg)
StateSupport easier access to health care, not just health insurance
Regulate direct to consumer marketing of drugs
Achieve parity and integration of mental health care into primary care provider offices
Harm reduction programs: Needle exchange, fentanyl test strips
Support education and campaigns to reduce stigma
Support meaningful employment, stable housing
![Page 73: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/73.jpg)
FederalBan marketing of opioids, stimulants and sedatives.
Update laws regarding treatment with methadone
Easier access to health care, not just insurance
Policies that prevent despair and support growth
Fraser M (2019). The Opioid Epidemic’s Prevention Problem. AJPH: 109: 2, 215-217.
![Page 74: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/74.jpg)
An interesting comparison . . .
First Opioid Epidemic (early 1900s)
Preceded by Industrial Revolution
Loss of jobs, economic instability
The Great Depression
Corporate marketing, increased drug use
Congressional Regulation
The New Deal
This Opioid Epidemic
Technological/ information Revolution
Loss of jobs, economic instability PLUS climate crisis/ anxiety
The Great Recession
Corporate marketing, increased drug use, MORE lethal substances
Congressional Regulation, scientific advances
? ?
![Page 75: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/75.jpg)
Grow your sphere of resilience
![Page 76: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/76.jpg)
![Page 77: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/77.jpg)
![Page 78: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/78.jpg)
Overdoses by Specific Opioid
Source: CDC/NCMS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2017. https://wonder.cdc.gov
www.cdc.govYour Source for Credible Health Information
![Page 79: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/79.jpg)
![Page 80: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/80.jpg)
Cicero T et al. JAMA Psychiatry. 2014; Cicero T et al. Addict Beh. 2017
Shifting Patterns of First Opioid UsedTreatment Admissions for Heroin Use Disorder
![Page 81: Opioid Epidemic: A Hopeful Roadmap for the Future...“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Characterized by: Needing](https://reader033.fdocuments.in/reader033/viewer/2022050113/5f4a65ac9af1267050103f84/html5/thumbnails/81.jpg)
Purity % CostHeroin Purity and Cost
Institute for Defense Analysis and ONDCP