1

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Prescription Drug Abuse:Trends and Consequences

__________________________________________________

Prescription Drug Abuse:Trends and Consequences

__________________________________________________

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A “Putting the Pieces Together for “Putting the Pieces Together for Children and Families”Children and Families”

The National Conference on The National Conference on Substance Abuse, Child Welfare Substance Abuse, Child Welfare

and the Courts and the Courts

“Putting the Pieces Together for “Putting the Pieces Together for Children and Families”Children and Families”

The National Conference on The National Conference on Substance Abuse, Child Welfare Substance Abuse, Child Welfare

and the Courts and the Courts

NO

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WES

TH

IGH

I

Gaylord National Resort and Convention CenterPotomac National Harbor, Maryland

September 15, 2011

Steven Freng, Psy.D., MSWSteven Freng, Psy.D., MSWNW HIDTA Prevention/Treatment ManagerNW HIDTA Prevention/Treatment Manager

Gaylord National Resort and Convention CenterPotomac National Harbor, Maryland

September 15, 2011

Steven Freng, Psy.D., MSWSteven Freng, Psy.D., MSWNW HIDTA Prevention/Treatment ManagerNW HIDTA Prevention/Treatment Manager

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EA What is a HIDTA?What is a HIDTA?

“HIGH INTENSITY DRUG TRAFFICKING

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A

AREA”

HIDTAs are part of the national drug control strategy. They are grant programs managed by the Office of National Drug Control Policy,

awarded to geographic areas that are

NO

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TH

IGH

I awarded to geographic areas that are considered to be critical centers of drug production, manufacturing, importation, distribution and/or chronic consumption.

AFF

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EAIN

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UG

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NO

RTH

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IGH

I

AFF

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EA Northwest HIDTANorthwest HIDTAWhatcom

Skagit

OkanoganFerry

Stevens

PendOrielle

Island

San Juan

INTE

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A

Snohomish

King

Clallam

Jefferson

GraysHarbor Mason

ThurstonPierce

Kittitas

Chelan

DouglasSpokaneLincoln

WhitmanAdams

Grant

KitsapN

OR

THW

EST

HIG

HI

PacificLewis

Wahkiakum

Cowlitz

Clark

Skamania

Klickitat

Yakima Franklin

Benton

Walla Walla

Columbia

Asotin

Garfield

2

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EA Northwest HIDTA StrategyCombining Public Safety and Public Health

Approaches:

Northwest HIDTA StrategyCombining Public Safety and Public Health

Approaches:

INTE

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A

ENFORCEMENTInvestigative Support

Task Force Support

PREVENTION TREATMENT

NO

RTH

WES

TH

IGH

I

Community Coalition Support

Public Education & Awareness

Drug Court Programs

Data Management & Evaluation

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EA Threat IndicatorsThreat Indicators“Critical Events” registered with the

NW HIDTA by 61 L E A s in 1998:

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A NW HIDTA by 61 L.E.A.s in 1998:

• Cocaine: 128• Methamphetamine 79• Heroin 33

NO

RTH

WES

TH

IGH

I • Marijuana: 27• Other: _6_

273

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EA Percentage CEV by Drug

40%

45%

50%

INTE

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A

15%

20%

25%

30%

35%

METHCOCAINEMARIJUANAHEROINMDMAOTHER

NO

RTH

WES

TH

IGH

I

0%

5%

10%

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

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EA Threat IndicatorsThreat Indicators“Critical Events” registered with the

NW HIDTA by 75 L E A s in 2010:

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A NW HIDTA by 75 L.E.A.s in 2010:

• Methamphetamine: 819• Marijuana: 639• Cocaine 475• Rx Opiates: 413

NO

RTH

WES

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IGH

I • Rx Opiates: 413• Heroin: 383• MDMA (Ecstasy): 97• Other: 146

2,972

3

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EA Psychoactive Drugs by Psychoactive Drugs by Group/TypeGroup/Type

•• NicotineNicotine

INTE

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A •• NicotineNicotine•• MarijuanaMarijuana•• StimulantsStimulants•• OpiatesOpiates•• SedativesSedatives

NO

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WES

TH

IGH

I

•• “Atypical” Drugs“Atypical” Drugs•• HallucinogensHallucinogens

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EA What Makes a Substance “Psychoactive”?

What Makes a Substance “Psychoactive”?

• Psychoactive substances -- “drugs” -- modify the neurochemistry of the reward/pleasure process

INTE

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A neurochemistry of the reward/pleasure process

• Drugs activate or imitate the chemicals --neurotransmitters -- associated with and/or located in the reward/pleasure center

• Specifically, drugs stimulate the release of dopamine and endorphin but in an enhancedmanner

NO

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WES

TH

IGH

I manner

• Dopamine produces “excited euphoria”, endorphin produces “calm euphoria”

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EA Factors Contributing to AbuseFactors Contributing to Abuse

• Biological predisposition

INTE

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A

• Childhood experiences – modeling, neglect and abuse, depression, trauma

• Culture, normsL k f i i b i

NO

RTH

WES

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IGH

I • Lack of socioeconomic barriers• Underlying mood, affective disorders,

PTSD

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EA

AddictionAddiction• Addiction is a “disease of the brain”, most descriptively

defined by a progressive loss of control over use

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A y p g

• Addiction entails four criteria:– compulsion -- involuntary, irrational usage behaviors– continued use despite adverse consequences– craving -- intense, irrational psychological preoccupation– denial -- a distortion of perception caused by craving

Addi ti i l d Ab ti S d t ti f

NO

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WES

TH

IGH

I • Addiction includes Abstinence Syndrome at cessation of use -withdrawal is comprised of symptoms that are described as a “rebound effect” from the particular drug to which the user has become dependent

4

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EA Types of Commonly Abused Types of Commonly Abused Prescription DrugsPrescription Drugs

•• Stimulants Stimulants ----

INTE

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A • Prescribed to treat narcolepsy and attention deficit/hyperactivity disorder (Ritalin, Adderal)

•• Sedatives Sedatives ----• Prescribed to treat anxiety and sleep disorders

(Phenobarbital, Valium, Xanax)•• OpiatesOpiates

NO

RTH

WES

TH

IGH

I •• OpiatesOpiates ----• Prescribed to treat acute and chronic pain

(Hydrocodone, Oxycontin, Methadone)

AFF

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EAIN

TEN

SITY

DR

UG

TRA

NO

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I

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EA

To help protect your privacy, PowerPoint prevented this external picture from being automatically downloaded. To download and display this picture, click Options in the Message Bar, and then click Enable external content.

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AN

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EST

HIG

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Abuse/Dependence on Illicit Drugs in the Abuse/Dependence on Illicit Drugs in the Past Year (aged 12 or older)Past Year (aged 12 or older)

INTE

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AN

OR

THW

EST

HIG

HI

5

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Positive Employee Drug TestsPositive Employee Drug TestsAmong U.S. Workers, 1999 and 2009 Among U.S. Workers, 1999 and 2009

INTE

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A

Amphetamines4.5%

Opiates*7.5%

Marijuana62.2%

Cocaine16.2%

Marijuana43.7%

Cocaine7.3%

Opiates*20.1%

Amphetamines13.1%

Oth *Sedatives*

Sedatives* 11.2%Other*

1999 2009

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I

Source: CESAR FAX, CESAR@cesar.umd.edu or www.cesar.umd.edu

Other*4.5%

Sedatives*6.5%

Other3.1%

*The category “opiates” comprises methadone, propoxyphene, oxycodone, and other opiates. The category “sedatives” comprises barbiturates and benzodiazepines. The category “other” comprises PCP, acid/base, oxidizing

adulterants, substituted urines, and invalid specimens.

AFF

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EAIN

TEN

SITY

DR

UG

TRA

NO

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I

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EA

SedativesSedatives0.4 million0.4 million

Past Month Use Among Past Month Use Among Persons Age 12 and Older Persons Age 12 and Older (2009) (2009)

INTE

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A

StimulantsStimulants

5 2 million5 2 millionNarcotic Pain RelieversNarcotic Pain Relievers

AntiAnti--Anxiety MedicationAnxiety Medication

1.2 million1.2 million

1.8 million1.8 million

NO

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IGH

I

(Compared to:(Compared to:Marijuana Marijuana -- 16.7 16.7 millionmillionCocaine Cocaine -- 1.6 1.6 millionmillionMethamphetamine Methamphetamine -- 500,000500,000Heroin Heroin -- 200,000 )200,000 )

5.2 million5.2 million

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EA Rx Medications HeadlinesRx Medications Headlines• Past-year initiation of non-medical prescription

medication use has surpassed the rate for marijuana – 2,500 youth use Rx drugs to get high for the

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A first time every day.

• Seven out of the top ten drugs used by teens are prescription medications.

• E-R visits involving the non-medical use of prescription opiates increased 111% from 2004 to 2008 – 71,000 people were admitted to hospitals for overdoses in 2006.

NO

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WES

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IGH

I

• Treatment admissions for addiction to prescription opiates increased 400% from 1997 to 2007.

• 39% of heroin users responding to a 2009 needle exchange survey in King County reported addiction to Rx opiates prior to using heroin.

6

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OpiatesOpiatesIN

TEN

SITY

DR

UG

TRA

• Natural - Opium, morphine, codeine• Semi-synthetic - Heroin, Dilaudid (hydromorphone)• Synthetics - Oxycontin®, Percodan®, Percoset®

(oxycodone, derived from morphine)Vicodin®, Lortab® (hydrocodone)Methadose® Dolophine® (methadone)

NO

RTH

WES

TH

IGH

I Methadose®, Dolophine® (methadone)Darvon® (propoxyphene) Demerol® (meperidine)Duagesic® (fentanyl)

AFF

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EA OpiatesOpiates• Opium, heroin, morphine, codeine, Dilaudid,

Percodan, Demerol, Methadone, Fentanyl

INTE

NSI

TYD

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A

– Potent analgesics– Relatively short half-life, tolerance develops very rapidly

with frequent use– Overwhelming sense of well-being, altering the subjective

experience of physical and emotional pain – Gastrointestinal symptoms most common among chronic

users

NO

RTH

WES

TH

IGH

I users– Relatively mild withdrawal syndrome (especially when

compared to alcohol/sedatives)– Severe health risks due to intravenous administration,

including HIV/AIDS, Hepatitis, aggressive infections

AFF

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EA Prescription Opiates• Obtained legally by prescription; obtained illegally

from friends/family (free or purchased), through

INTE

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A o e ds/ a y ( ee o pu c ased), t ougmultiple providers, via theft, illegitimate prescriptions, illegal Internet pharmacies

• Now also trafficked by numerous DTOs as “part of the inventory”

• Prescription opiates ranked 5th in prevalence within the region

NO

RTH

WES

TH

IGH

I the region

• Prescription opiates ranked 5th as a regional threat

• Prices for illicit purchase vary: unreformulated oxycodone sells for $1 per milligram

AFF

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EA Vicodin (hydrocodone)Vicodin (hydrocodone)•• Includes Acetaminophen (Tylenol)Includes Acetaminophen (Tylenol)•• Narcotic/Opioid pain relieverNarcotic/Opioid pain reliever•• Used to relieve moderate to severe pain Used to relieve moderate to severe pain •• Antitussive (cough suppressant)Antitussive (cough suppressant)

INTE

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TYD

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GTR

A Antitussive (cough suppressant)Antitussive (cough suppressant)•• Structurally similar to codeine but with effects more Structurally similar to codeine but with effects more

similar to morphine similar to morphine •• HabitHabit--forming: use/abuse of hydrocodone is associated forming: use/abuse of hydrocodone is associated

with tolerance, dependence, and addictionwith tolerance, dependence, and addiction•• Risk of liver toxicity when high, acute doses are Risk of liver toxicity when high, acute doses are

consumed consumed •• Schedule IIISchedule III

NO

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IGH

I •• Schedule IIISchedule III•• 119 million prescriptions written in U.S. in 2007119 million prescriptions written in U.S. in 2007

7

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EA Oxycontin (oxycodone) Oxycontin (oxycodone) • Opioid pain reliever • Used to treat moderate to high pain• Oxycodone the medication's active ingredient is

INTE

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A • Oxycodone, the medication s active ingredient, is produced in a timed-release tablet

• Has been abused illicitly for the past 30+ years• Drug addicts crush and then snort, inject, smoke the pills

to bypass the time-release outer layer • Schedule II• 38 million prescriptions written in U S in 2007

NO

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IGH

I • 38 million prescriptions written in U.S. in 2007

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EA MethadoneMethadone•• Developed to treat heroin dependence.Developed to treat heroin dependence.•• Now also widely prescribed for pain due changes in pain Now also widely prescribed for pain due changes in pain

management practices (prescribing has increased by 700%management practices (prescribing has increased by 700%

INTE

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A management practices (prescribing has increased by 700% management practices (prescribing has increased by 700% since 1996). since 1996).

•• In 2005, 41,216 Emergency Room visits involved nonIn 2005, 41,216 Emergency Room visits involved non--medical use of medical use of methadonemethadone

•• From 1999 to 2004, methadone deaths jumped from 786 to 3,849From 1999 to 2004, methadone deaths jumped from 786 to 3,849•• Much longer halfMuch longer half--life than other opiates, remains in the blood after life than other opiates, remains in the blood after

analgesia effects have worn off, increasing the danger of taking analgesia effects have worn off, increasing the danger of taking too muchtoo much

NO

RTH

WES

TH

IGH

I too much too much •• In 2004, 10 people died from methadone toxicity every day In 2004, 10 people died from methadone toxicity every day •• Schedule IISchedule II

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EA Classic Sign of Opiate UseClassic Sign of Opiate Use

INTE

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AN

OR

THW

EST

HIG

HI

AFF

ICK

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AR

EAIN

TEN

SITY

DR

UG

TRA

NO

RTH

WES

TH

IGH

I

8

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EA Adolescent Pharmaceutical Pain Medication Misuse

Percentage of Youths Ages 12 to 17 Reporting Lifetime Misuse†

of Prescription Pain Relievers, 1968 to 2004*

INTE

NSI

TYD

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GTR

A

Percentageof Youths

2%

4%

6%

8%

10%

12%

p

NO

RTH

WES

TH

IGH

I

6566

6768

6970

7172

7374

7576

7778

7980

8182

8384

8586

8788

8990

9192

9394

9596

9798

9900

010203*

04*0%

YearSOURCES: Adapted by CESAR from Sung H.-E., Richter L., Vaughan R., Johnson P.B., Thom B.

“Nonmedical Use of Prescription Opioids Among Teenagers in the United States: Trends and Correlates,” Journal of Adolescent Health 37(1):44-51, 2005; and Substance Abuse and Mental Health Services Administration, Overview of Findings from the 2004 National Household Survey on Drug Use and Health, 2005. For more information, contact Dr. Hung-En Sung at hsung@casacolumbia.org.

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Percentage of U.S. Substance Abuse Treatment Admissions That Reported Any Pain Reliever Abuse, by Age Group 1998 and 2008

Percentage of U.S. Treatment Admissions Involving Pain Percentage of U.S. Treatment Admissions Involving Pain Reliever Abuse Increased More Than Fourfold Reliever Abuse Increased More Than Fourfold

from 1998 to 2008from 1998 to 2008

INTE

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A Age Group, 1998 and 2008

10%

20%

5.2%

13.7% 13.5%

7.6% 6.4% 6.1%3 9%

1998 2008

NO

RTH

WES

TH

IGH

I

12 to 17 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 or older

Age of Admission

0%0.6% 1.5% 2.1% 2.9% 3.1% 1.9% 2.0%

3.9%

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Estimated Number of Emergency Department (ED) Visits Involving the Nonmedical Use of Narcotic Pain Relievers, 2004 and 2008

Number of U.S. ED Visits Involving Nonmedical Use Number of U.S. ED Visits Involving Nonmedical Use of Narcotic Pain Relievers More Than Doubled of Narcotic Pain Relievers More Than Doubled

from 2004 to 2008from 2004 to 2008

INTE

NSI

TYD

RU

GTR

A ,

Oxycodone

Hydrocodone

Methadone

Morphine

41,701

39,844

36,806

13,966

105,214

89,051

63,629

2004 2008

NO

RTH

WES

TH

IGH

I

0 40,000 80,000 120,000

Morphine

Fentanyl

Hydromorphone

9,823

3,385

28,818

20,179

12,142

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EA EE--R Visits Involving Illicit DrugsR Visits Involving Illicit DrugsBy Age and Drug, 2009 (DAWN)By Age and Drug, 2009 (DAWN)

INTE

NSI

TYD

RU

GTR

AN

OR

THW

EST

HIG

HI

9

AFF

ICK

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EA EE--R Visits Involving Rx DrugsR Visits Involving Rx DrugsBy Age and Drug, 2009 (DAWN)By Age and Drug, 2009 (DAWN)

INTE

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AN

OR

THW

EST

HIG

HI

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EA DrugDrug--Related ERelated E--R Visits by TypeR Visits by Type20042004--09 (DAWN)09 (DAWN)

INTE

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AN

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EA

Unintentional Overdose Deaths, U.S.Unintentional Overdose Deaths, U.S.19701970--20062006

INTE

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AN

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EST

HIG

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EA Drug Overdose Deaths by DrugDrug Overdose Deaths by DrugU.S., 1999U.S., 1999--20062006

INTE

NSI

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AN

OR

THW

EST

HIG

HI

10

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EA Unintentional drug overdose death rates and Unintentional drug overdose death rates and total sales of prescription opioid painkillers by year in total sales of prescription opioid painkillers by year in

the United Statesthe United States

8 600

INTE

NSI

TYD

RU

GTR

A

2

3

4

5

6

7

Cru

de ra

te p

er 1

00,0

00

200

300

400

500

Sale

s in

mg/

pers

on

Deaths/100,000

Opioid sales(mg/person)

NO

RTH

WES

TH

IGH

I

0

1

2

'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06

C

0

100

88

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EA Drug Overdose Death Rates by StateDrug Overdose Death Rates by State20062006

INTE

NSI

TYD

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GTR

AN

OR

THW

EST

HIG

HI

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EA StimulantsStimulants• Caffeine, Cocaine, Methamphetamine, Ecstasy,

Ritalin, Adderal, Ephedra (Ma Huang)• Vary in half-life -- initial dose intensity is similar, with

differences in duration rapid development of tolerance

INTE

NSI

TYD

RU

GTR

A differences in duration -- rapid development of tolerance and high risk for dependence, bingeing

• Euphoria, pleasurable energy enhancement prompting physical activity, magnified sensory awareness, wakefulness, initial sense of improved cognition

• Subsequent distractibility, altered perception and paranoia

• Increased respiration and blood pressure hyperthermia

NO

RTH

WES

TH

IGH

I Increased respiration and blood pressure, hyperthermia, cardiac and multiple organ stress

•

• Sleep disruption/insomnia, tremors, seizures

• Protracted withdrawal, severe craving and anhedonia

• Reported long-term cognitive, emotional, memory deficits

AFF

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EA RitalinRitalin• Generic Name: methylphenidate

Brand Names: Concerta Metadate

INTE

NSI

TYD

RU

GTR

A – Brand Names: Concerta, Metadate • Used to treat attention:

– Attention deficit disorder (ADD)– Attention deficit/hyperactivity disorder (ADHD)– narcolepsy (an uncontrollable desire to sleep)

• Affects chemicals in brain and nerves that contribute to hyperactivity and impulse control.

• Effects similar to those of cocaine and amphetamines

NO

RTH

WES

TH

IGH

I • Effects similar to those of cocaine and amphetamines. • Schedule II

11

AFF

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EA AdderalAdderal• Generic Name: amphetamine and dextroamphetamine

– Brand Names: Adderal, Adderal XR

INTE

NSI

TYD

RU

GTR

A

• Central nervous system stimulant• Affects chemicals in the brain and nerves that contribute to

hyperactivity and impulse control • Schedule II

NO

RTH

WES

TH

IGH

I

AFF

ICK

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EA Misuse of Prescription StimulantsMisuse of Prescription Stimulants

• A recent study reveals a 76% increase in calls to Poison Control Centers regarding adolescent

INTE

NSI

TYD

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GTR

A Poison Control Centers regarding adolescent misuse of ADHD medications.

• Calls reporting misuse rose from 330 in 1998 to 581 in 2005. During the same span, prescriptions for the medications rose 86% among children ages 10 to 19.

NO

RTH

WES

TH

IGH

I

• Four fatalities were among the calls, and 42% of the teens involved in the calls had moderate to severe side-effects.

AFF

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EA

Classic Sign of Stimulant Use Classic Sign of Stimulant Use

INTE

NSI

TYD

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GTR

AN

OR

THW

EST

HIG

HI

AFF

ICK

ING

AR

EA SedativesSedatives

• Alcohol, barbiturates, benzodiazepines, “Z-drugs”, antihistamines Chloral Hydrate rohypnol

INTE

NSI

TYD

RU

GTR

A antihistamines, Chloral Hydrate, rohypnol, GHB

– Known variously as hypnotics, anxiolytics, tranquilizers, soporifics

– Central Nervous System depressants– Short to very long half-life, defining the timeframes for the

development of tolerance and dependence

NO

RTH

WES

TH

IGH

I

– Severe withdrawal syndromes– Chronic addictive use can be VERY debilitating, with

cognitive, organic and resiliency-related effects– Serves to weaken, accelerates aging, creates morbidity in

the most vulnerable organ system/genetic history (liver, brain, pancreas, cardio-vascular, G.I., etc.)

12

AFF

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EA

Xanax (aplrazolam)Xanax (aplrazolam)

•• A Benzodiazepine for: A Benzodiazepine for:

INTE

NSI

TYD

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GTR

A pp–– Anxiety disordersAnxiety disorders–– Panic disordersPanic disorders–– Anxiety caused by depression Anxiety caused by depression

NO

RTH

WES

TH

IGH

I

AFF

ICK

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EA

Valium (diazepam)Valium (diazepam)

• A Benzodiazepine for:

INTE

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TYD

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GTR

A – Anxiety disorders – Agitation– Shakiness– Hallucinations during alcohol withdrawal– Muscle pain

NO

RTH

WES

TH

IGH

I

AFF

ICK

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AR

EA

PhenazepamPhenazepam

INTE

NSI

TYD

RU

GTR

A

• A Benzodiazepine for:– Epilepsy– Insomnia– Alcohol Withdrawal Syndrome– Anxiety

NO

RTH

WES

TH

IGH

I – Anxiety– Insomnia

• Developed in Russia, available on the Internet• Not a Scheduled Drug in the U.S. or Europe• Notably associated with overdose deaths

AFF

ICK

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AR

EAIN

TEN

SITY

DR

UG

TRA

NO

RTH

WES

TH

IGH

I

13

AFF

ICK

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EA

Treatment ConsiderationsTreatment Considerations• Effectiveness increases when the program draws on a variety

of components

INTE

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GTR

A • Length of treatment/program retention is important• Basic treatment models:

– Medical (Disease Concept)– Psychosocial (family, social network)– Biopsychosocial (biological)

• In-patient, intensive out-patient, out-patient• Cognitive-behavioral therapies for decision-making and

behavior change

NO

RTH

WES

TH

IGH

I g• Medications, psychiatric, health and dental care• Pregnant/parenting women, sexual orientation, homelessness• Relapse prevention should include several strategies:

– Drug education– Family and group therapies– Self-help groups

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ING

AR

EA Treatment ApproachesTreatment Approaches• Matrix Model• Individualized Counseling

INTE

NSI

TYD

RU

GTR

A • Individualized Counseling• Contingency Management• Supportive-Expressive Psychotherapy• Motivational Enhancement Therapy• CBT: MRT, Seeking Safety• Behavioral Therapy for Adolescents

NO

RTH

WES

TH

IGH

I • Multidimensional Family Therapy (MDFT) for Adolescents

• Relapse Prevention• Medication-enhanced Interventions

AFF

ICK

ING

AR

EA

Medication Assisted TreatmentMedication Assisted Treatment

Medications address several different

INTE

NSI

TYD

RU

GTR

A

elements of addiction

– Treat withdrawal symptoms

– Reduce craving during abstinence

– Prevent neurochemical action (antagonist)

NO

RTH

WES

TH

IGH

I

– Replace neurochemical action (agonist)

AFF

ICK

ING

AR

EA Medications AvailableMedications Available• Alcohol

– Disulfiram (Antabuse)– Naltrexone (Revia, Vivitrol)– Acamprosate (Camprol)

INTE

NSI

TYD

RU

GTR

A Acamprosate (Camprol)

• Nicotine– Gum, patches, nasal sprays– Buprorion (Zyban, Wellbutrin)– Vaccine under trials

• Cocaine– Disufiram (Antabuse)

NO

RTH

WES

TH

IGH

I Disufiram (Antabuse)– Topirimate– Modanifil– 2 vaccines under trials

• Amphetamine, Marijuana– Nothing yet

14

AFF

ICK

ING

AR

EA Opiate MedicationsOpiate Medications• Methadone – agonist

• Buprenorphine - partial agonist

N l i (R Vi Vi i l)

INTE

NSI

TYD

RU

GTR

A • Naltrexone - antagonist (ReVia, Vivitrol)– Opiate “blocker” – helps maintain abstinence from opiates– Detoxification from physical dependence on opiates– Vivitrol is an injectable, long lasting form of Naltrexone

and is also approved for the treatment of alcohol dependence

( )

NO

RTH

WES

TH

IGH

I • Naloxone - antagonist (Narcan)– Treatment for acute opiate overdose

• Clonidine (Catapres)– Not an agonist or antagonist but suppresses withdrawal

symptoms

AFF

ICK

ING

AR

EA Prenatal Prescription Drug Use Prenatal Prescription Drug Use in WA State, 2000in WA State, 2000--0808

90

INTE

NSI

TYD

RU

GTR

A

4050607080

MethRx Opiates

NO

RTH

WES

TH

IGH

I

0102030

2000 2006 2007 2008

AFF

ICK

ING

AR

EA Pediatric Interim Care Center (PICC)2010 Statistics

Pediatric Interim Care Center (PICC)2010 Statistics

• Methadone + 1-8 illegal drugs/Rx meds 26• Opiates + 1-5 illegal drugs/Rx meds 25

INTE

NSI

TYD

RU

GTR

A • Opiates + 1-5 illegal drugs/Rx meds 25• Methamphetamine 11• Heroin + 1-3 illegal drugs/Rx meds 8• Meth + 1-2 illegal drugs/Rx meds 8• Cocaine 7• Methadone 6• Opiate 6

Cocaine + 1 illegal drug 3

NO

RTH

WES

TH

IGH

I • Cocaine + 1 illegal drug 3• Heroin 1• Alcohol 1• Benzodiazepine 1

Opiates: 72Opiates: 72Stimulants: 29Stimulants: 29

AFF

ICK

ING

AR

EA

Prenatal Exposure to OpiatesPrenatal Exposure to Opiates

•• TremorsTremors•• Poor self consolabilityPoor self consolability

INTE

NSI

TYD

RU

GTR

A •• Poor self consolabilityPoor self consolability•• Poor feedingPoor feeding•• Growth challengesGrowth challenges•• Sleep deprivationSleep deprivation•• GI crampsGI cramps•• Frantic movementFrantic movement•• Fast respirationsFast respirations

NO

RTH

WES

TH

IGH

I Fast respirationsFast respirations

15

AFF

ICK

ING

AR

EA

Prenatal Exposure to StimulantsPrenatal Exposure to Stimulants

•• LethargicLethargic--Excessive SleepExcessive Sleep

INTE

NSI

TYD

RU

GTR

A •• LethargicLethargic--Excessive Sleep Excessive Sleep •• Poor Suck and Swallow CoordinationPoor Suck and Swallow Coordination•• Sleep ApneaSleep Apnea•• Poor Habituation Poor Habituation

NO

RTH

WES

TH

IGH

I

AFF

ICK

ING

AR

EA Drugs in CombinationDrugs in Combination

• Additive Effect: When two or more drugs are taken at the same time, and the action of one plus the action of the other results in an action as if just one drug had been given An

INTE

NSI

TYD

RU

GTR

A results in an action as if just one drug had been given. An example would be a barbiturate and a benzodiazepine given together before surgery to relax a patient.

• Potentiation: Occurs when two drugs are taken an one of them intensifies the action of the other. An example would be an antihistamine given with an opiate to intensify its effect, lessening the amount of the opiate needed.

NO

RTH

WES

TH

IGH

I

• Synergism: When two drugs with similar actions are taken together resulting in an exaggerated action, out of proportion to that of each drug taken separately. An example would be alcohol taken together with an opiate.

AFF

ICK

ING

AR

EA

Availability and AccessibilityAvailability and Accessibility• 20.8% of survey respondents reported using at

least one prescribed opioid medication during

INTE

NSI

TYD

RU

GTR

A least one prescribed opioid medication during the preceding 12 months

• 72% reported having leftover medication

• 71% reported keeping the medication

Th f t l t 10% f h h ld

NO

RTH

WES

TH

IGH

I • Therefore, at least 10% of households are accumulating medications each year

AFF

ICK

ING

AR

EA

Preventing Rx Drug Abuse Among TeensPreventing Rx Drug Abuse Among Teens

• Safeguard all drugs at home – monitor quantities and control access

INTE

NSI

TYD

RU

GTR

A and control access• Set clear rule for teens about all drug use, including

not sharing medicine and always following medical advice and dosages

• Be a good role model by following these same rules with your own medicines

P l l d di f ld d

NO

RTH

WES

TH

IGH

I • Properly conceal and dispose of old or unused medicines

• Ask friends and family to safeguard their prescription drugs as well

16

AFF

ICK

ING

AR

EAIN

TEN

SITY

DR

UG

TRA

NO

RTH

WES

TH

IGH

I

AFF

ICK

ING

AR

EA

• Education for Medical Care ProfessionalsEd cational Pilot G idelines for Opioid dosing

Prevention StrategiesPrevention Strategies

INTE

NSI

TYD

RU

GTR

A – Educational Pilot: Guidelines for Opioid dosing for chronic, non-cancer pain http://www.agencymeddirectors.wa.gov/guidelines.asp

– Rule making in process to create a single set of pain (opioid) management guidelines HB 2876

• Clinical Interventions

NO

RTH

WES

TH

IGH

I • Clinical Interventions– Medicaid

• Narcotic Review Program• Patient Review and Coordination Program

AFF

ICK

ING

AR

EAIN

TEN

SITY

DR

UG

TRA

NO

RTH

WES

TH

IGH

I

Greater Spokane Substance Abuse Council (GSSAC)

Working Together Toward Safe Communities

Free From Substance Abuse

NW High Intensity Drug Trafficking Area (HIDTA)

AFF

ICK

ING

AR

EA A Companion ProgramA Companion Program

• WA Meth Watch

INTE

NSI

TYD

RU

GTR

A

– Education and prevention on dangers of methamphetamine

– Helped to reduce meth labs

• WA Rx Watch

NO

RTH

WES

TH

IGH

I WA Rx Watch– Increase awareness

about prescription drug abuse, addiction and prevention

17

AFF

ICK

ING

AR

EA

Rx Watch Program Goals Rx Watch Program Goals

Designed to help stop Prescription Drug Abuse

INTE

NSI

TYD

RU

GTR

A Designed to help stop Prescription Drug Abuse

– With strong collaboration with Law Enforcement, Treatment, and the Medical Community

– Community Presentations that build awareness and

NO

RTH

WES

TH

IGH

I educate the public on the dangers of Rx drug abuse

– Designed for Washington State

AFF

ICK

ING

AR

EA Saturday, October 29, 2011Saturday, October 29, 2011To find a participating location:To find a participating location:

–– Visit Visit TakeBackYourMeds.org/deaTakeBackYourMeds.org/dea--eventsevents–– Call 1 888 869 4233Call 1 888 869 4233

INTE

NSI

TYD

RU

GTR

A Call 1.888.869.4233Call 1.888.869.4233

Municipalities and counties in 19 states have implemented Municipalities and counties in 19 states have implemented programs.programs.

DEA must approve, but local support/funding is typically DEA must approve, but local support/funding is typically unsustainable.unsustainable.

Many citizens think the drug manufacturers should provide takeMany citizens think the drug manufacturers should provide take--

NO

RTH

WES

TH

IGH

I

back of leftover medicines as part of doing business, back of leftover medicines as part of doing business, as they as they do in other countriesdo in other countries..

AFF

ICK

ING

AR

EA

QUESTIONS?QUESTIONS?

INTE

NSI

TYD

RU

GTR

A

Contact Information/Resources

Tel: 206.352.3603sfreng@nw.hidta.org

NO

RTH

WES

TH

IGH

I

“M-Files”: www.mfiles.org

ONDCP: whitehousedrugpolicy.gov