Prescription Opioid Abuse Historical Aspects 1990 - Current - PowerPoint PPT Presentation

Loading...

PPT – Prescription Opioid Abuse Historical Aspects 1990 - Current PowerPoint presentation | free to download - id: 8573eb-ZDQyO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Prescription Opioid Abuse Historical Aspects 1990 - Current

Description:

Prescription Opioid Abuse Historical Aspects 1990 - Current Through the efforts of pain control advocates, organized medicine, scientific journals, & malpractice ... – PowerPoint PPT presentation

Number of Views:32
Avg rating:3.0/5.0
Slides: 24
Provided by: RobR198
Learn more at: http://uwf.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Prescription Opioid Abuse Historical Aspects 1990 - Current


1
Prescription Opioid Abuse Historical Aspects 1990
- Current
  • Through the efforts of pain control advocates,
    organized medicine, scientific journals,
    malpractice suits, prescribing opiates for pain
    became more common during the last decade of the
    20th Century
  • Opioid therapy became accepted (although often
    inadequately) for treating acute pain, pain due
    to cancer, pain caused by a terminal disease
  • Still disputed is the use of opioids for chronic
    pain not associated with terminal disease

2
Evolving Landscape of Drugs of Abuse
Farming
Pharming
2
3
Prescription Opioids
  • Fastest growing drug abuse
  • Usually used orally but may be crushed snorted
    or injected
  • Injection more likely with Oxycontin
  • More frequent source medicine cabinets
    prescriptions
  • Believed to be safer than illicit street drugs

4
Epidemiology
  • In 2001, 8 million persons abused prescription
    pain relievers at least once during previous 12
    months
  • In 2004, this had jumped to 11.4 million
  • 2005 NSDUH, 5 non-medical use of rx pain meds in
    those 12 and older
  • Prescription meds second only to marijuana as
    most commonly abused drugs (no etoh)

5
(No Transcript)
6
Potential subpopulations of prescription Opioid
Abusers
  • Persons who abuse or are dependent on only
    prescription opioids
  • Abusers of other opioids, e.g., heroin, when they
    cannot get their drug of choice
  • Polydrug abusers
  • Pain patients who develop abuse or dependence
    problems on these drugs in the course of
    legitimate medical treatment

7
Why Has the Abuse of Prescription Drugs Been
Increasing?
  • Increasing numbers of prescriptions (greater
    availability)
  • Attention by the media advertising (television
    and newspaper)
  • Easier access (e.g. internet availability)
  • Improper knowledge monitoring (adverse effects
    go unrecognized)
  • Others?

8
As Prescriptions Increase, Emergency Room Reports
Have Increased at the Same or Faster Rate
9
Increased Media Attention
10
Commonly known Mechanisms of Diversion
  • Illegal sale of prescriptions by physicians
  • Illegal sale of prescriptions by pharmacists
  • Doctor Shopping by individuals who visit
    numerous physicians to obtain multiple
    prescriptions
  • Illegal substitutions or shorting by
    pharmacists
  • Theft, forgery, or alteration of prescriptions
    Robberies thefts from pharmacies thefts of
    institutional drug supplies
  • Internet sales

11
Easy Access Role of the Internet? Delivered in
the Privacy of your Home
Some reasons why you should consider using this
pharmacy No prescription required!
12
Changing Methods of Distribution
13
Less Often Discussed Mechanisms
  • Residential Burglaries
  • Obituary Shopping
  • Hotel residential sneak thefts
  • Supply-chain theft
  • In-production losses
  • In-transit losses
  • Returns/reverse distributors
  • Employee pilferage

14
Mechanisms of Diversion by Middle High School
Students
  • Thefts from family medicine cabinets
  • Drug switching at home
  • Drug trading at school
  • Thefts robberies of medications from classmates

15
ISSUES IN OPIOID ASSESSMENT
  • Types of Painkillers (synthetics typically give
    better highs)
  • Short acting Lortab (very common), percocet,
    vicodin
  • oxycontin lasts 12 hours ms contin morphine
    sulphate lasts 12 hrs.
  • 24-hr ms contin now available(kadian?)
  • duragesic fentanyl patch lasts 3 days check used
    patches for tampering (can get patches on the
    internet)
  • ultram (not an opiate)
  • some may combine soma (a muscle relaxer) and
    lortab gives good pop

16
Assessing Need for Narcotics (opioids)
  • realize very few chronic pain clients are
    addicts
  • assess for prior and current alcohol/drug
    problems
  • assess for self-medicating of psych disorders
  • do drug screen do they already have drug in
    them? Are they diverting their meds to the
    street? (oxycontin going for about 1 per
    milligram)
  • check pharmacies for multiple rx
  • assess pain level on and off meds are they
    helping functioning?

17
Assessing Need for Narcotics (opioids)
  • check compliance with medical tx if client only
    wants narcotics, be suspiciousare they willing
    to sign a medication use agreement/contract?
  • are there secondary gain issues involved? (e.g.,
    workmens comp.) poorer pain tx outcomes are
    associated with those in litigation.
  • type and dosage of drug currently taking in
    some, tolerance is so high that withdrawal
    symptoms (increased pain) may occur when taking a
    typical dose
  • rural vs. urban setting rx drug abuse worse in
    rural areas

18
Treatment Issues
Who is the Patient
  • Route
  • Oral
  • Intranasal
  • Injector
  • Comorbidity
  • Psychiatric
  • Chronic pain
  • Age
  • Adolescent
  • Adult
  • Elderly
  • Drug History
  • New onset of drug abuse
  • Relapser
  • Chronic poly substance abuser

19
Assessing Need for Narcotics
  • chronic opioid tx not appropriate for
  • those with active addictions
  • those who use etoh (liability)
  • those who refuse other types of tx
  • when QOL not improved after use of meds
  • for those with previous narcotics problems
  • opioids not given for lengthy amounts of time
  • need to be in tx / NA
  • client may underestimate risk of relapse

20
Treatment Options
  • Detoxification
  • To antagonist maintenance (naltrexone, nelmefene,
    depot naltrexone)
  • To residential therapeutic community
  • To abstinenceoriented programs (counseling, 12
    step programs)
  • Maintenance
  • Methadone, LAAM
  • Buprenorphine

21
Opiate Addiction Pharmacotherapy
  • Agonists Methadone, LAAM
  • Partial Agonists Buprenorphine
  • Antagonists Naltrexone
  • Anti-Withdrawal Methadone Buprenorphine
  • Clonidine rapid detox using
    Buprenorphine, Naltrexone, Clonidine
  • Anti-Craving Clonidine or Lofexidine

22
Advantages of Buprenorphine
  • Buprenorphine binds more tightly to the receptor
    than any other opiate
  • It is a partial mu agonist, occupying that
    receptor only 70- also kappa antagonist
  • Ceiling effect protects against overdosebut also
    limits degree of agonist effectceiling effect
    approximately 32 mg
  • Withdrawal easier than from methadone or heroin
  • Maintained patients describe
  • Clear headedness
  • Increased energy
  • Improved sleep mood stability
  • Easier to engage in therapy

23
Other Forms of Pain Management
  • epidural nerve blocks
  • radio frequencies zap nerve and deadens for up
    to 6 months
  • electrical stimulation blocks pain signals
  • relaxation techniques
  • Biofeedback
  • physical therapy / chiropractic
  • Acupuncture
  • morphine pump in body
  • other medications
  • Antidepressants
  • Neurontin
  • Flexoril
About PowerShow.com