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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
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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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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
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I awarded to geographic areas that are considered to be critical centers of drug production, manufacturing, importation, distribution and/or chronic consumption.
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EA Northwest HIDTANorthwest HIDTAWhatcom
Skagit
OkanoganFerry
Stevens
PendOrielle
Island
San Juan
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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:
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ENFORCEMENTInvestigative Support
Task Force Support
PREVENTION TREATMENT
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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
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TH
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I • Marijuana: 27• Other: _6_
273
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EA Percentage CEV by Drug
40%
45%
50%
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A
15%
20%
25%
30%
35%
METHCOCAINEMARIJUANAHEROINMDMAOTHER
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TH
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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
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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
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A •• NicotineNicotine•• MarijuanaMarijuana•• StimulantsStimulants•• OpiatesOpiates•• SedativesSedatives
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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
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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
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I manner
• Dopamine produces “excited euphoria”, endorphin produces “calm euphoria”
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EA Factors Contributing to AbuseFactors Contributing to Abuse
• Biological predisposition
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A
• Childhood experiences – modeling, neglect and abuse, depression, trauma
• Culture, normsL k f i i b i
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I • Lack of socioeconomic barriers• Underlying mood, affective disorders,
PTSD
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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
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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
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EA Types of Commonly Abused Types of Commonly Abused Prescription DrugsPrescription Drugs
•• Stimulants Stimulants ----
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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
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TH
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I •• OpiatesOpiates ----• Prescribed to treat acute and chronic pain
(Hydrocodone, Oxycontin, Methadone)
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AN
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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)
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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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Source: CESAR FAX, [email protected] 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.
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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
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(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.
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• 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
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WES
TH
IGH
I Methadose®, Dolophine® (methadone)Darvon® (propoxyphene) Demerol® (meperidine)Duagesic® (fentanyl)
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EA OpiatesOpiates• Opium, heroin, morphine, codeine, Dilaudid,
Percodan, Demerol, Methadone, Fentanyl
INTE
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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
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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
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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
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I the region
• Prescription opiates ranked 5th as a regional threat
• Prices for illicit purchase vary: unreformulated oxycodone sells for $1 per milligram
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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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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
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I •• Schedule IIISchedule III•• 119 million prescriptions written in U.S. in 2007119 million prescriptions written in U.S. in 2007
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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
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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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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%
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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
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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
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AN
OR
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EST
HIG
HI
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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
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A
Percentageof Youths
2%
4%
6%
8%
10%
12%
p
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WES
TH
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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 [email protected].
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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
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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
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TYD
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GTR
A ,
Oxycodone
Hydrocodone
Methadone
Morphine
41,701
39,844
36,806
13,966
105,214
89,051
63,629
2004 2008
NO
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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
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GTR
AN
OR
THW
EST
HIG
HI
9
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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
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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
OR
THW
EST
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EA
Unintentional Overdose Deaths, U.S.Unintentional Overdose Deaths, U.S.19701970--20062006
INTE
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AN
OR
THW
EST
HIG
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EA Drug Overdose Deaths by DrugDrug Overdose Deaths by DrugU.S., 1999U.S., 1999--20062006
INTE
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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
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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
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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
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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
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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
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EA RitalinRitalin• Generic Name: methylphenidate
Brand Names: Concerta Metadate
INTE
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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
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EA AdderalAdderal• Generic Name: amphetamine and dextroamphetamine
– Brand Names: Adderal, Adderal XR
INTE
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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
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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
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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.
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EA
Classic Sign of Stimulant Use Classic Sign of Stimulant Use
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AN
OR
THW
EST
HIG
HI
AFF
ICK
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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
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Xanax (aplrazolam)Xanax (aplrazolam)
•• A Benzodiazepine for: A Benzodiazepine for:
INTE
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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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A – Anxiety disorders – Agitation– Shakiness– Hallucinations during alcohol withdrawal– Muscle pain
NO
RTH
WES
TH
IGH
I
AFF
ICK
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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
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UG
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NO
RTH
WES
TH
IGH
I
13
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EA
Treatment ConsiderationsTreatment Considerations• Effectiveness increases when the program draws on a variety
of components
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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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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: [email protected]
NO
RTH
WES
TH
IGH
I
“M-Files”: www.mfiles.org
ONDCP: whitehousedrugpolicy.gov
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