addiction sg: Opioid Epidemic

Kensington

**Known for cheapest, purest heroin in the region -Started being laced with fentanyl -236 people fatally overdosed in Kensington in 2017 -Drug tourists -Many people first came because car accident or surgery left them addicted to pain killers

Philadelphia county

**has highest rate of overdose death of 10 most populous counties -75,000 people addicted to opioids

doctors over prescribing

--With acute pain patients, doctors often gave weeks -or-even months-long prescriptions when only a few days' worth was needed -Left patients with a lot of extra pills, all because a doctor wanted to play it safe to avoid patient complaints

The current opioid epidemic is the deadliest drug crisis in American history

-More Americans died of drug overdoses in 2016 than in the entirety of the Vietnam War. -Overdoses killed ~64,000 people last year, more than guns or car accidents. -Pace of opioid deaths is faster than the H.I.V. epidemic at its peak :O

Scale of Opioid Epidemic: %

-Roughly 21-29% of patients prescribed opioids for chronic pain misuse them -8 - 12% develop an opioid use disorder. -4 - 6% who misuse prescription opioids transition to heroin --About 75% of people who use heroin first misused prescription opioids -Number has decreased recently

fentanyl and analogs

-Unlike heroin, fentanyl and its analogs can be made fairly easily in a lab. -Far cheaper to produce, without the hassle of growing opium poppy and then converting the poppy into morphine and then into heroin

Criticisms of Opioid bill

-Vastly underfunded-nowhere near tens of billions each year experts argue are needed to address epidemic -Treatment focused on residential facilities, which aren't always supported by science and often don't use gold standard care (MAT)

Because methadone and buprenorphine are themselves opioids, some people view these treatments for opioid dependence as just substitutions of one addictive drug for another. but they provide benefits:

-allows patients to hold jobs, avoid street crime and violence, and reduce their exposure to HIV -Patients stabilized on these medications can also engage more readily in counseling and other behavioral interventions essential to recovery.

patterns in overdose deaths

-fentanyl & heroin deaths rising as painkiller overdoses go down slightly

Two formulations of Buprenorphine taken sublingually

1.) a pure form of the drug 2.) a more commonly prescribed formulation called Suboxone, which combines buprenorphine with the drug naloxone, an antagonist (or blocker) at opioid receptors.

dsuvia

10 times more powerful than fentanyl and the FDA just approved its usage

Carfentanil potency

10,000x more potent than morphine 100 times more potent than fentanyl

Patients and pain

50 million people suffered from chronic pain in 2016 --Safer non-opioid pain treatments often out of patients' reach -May not have insurance -Insurance may not cover treatment -May not be health care centers near by that offer treatments

how much fentanyl is considered lethal?

About two milligrams—about what comes out with a single shake of a salt shaker

Carfentanil

All of the zookeepers and vets in the United States combined need only about 18 grams of carfentanil a year, about the weight of 18 artificial sweetener packets. --A few grains can kill a human --Absorbed through the skin -Challenge for first responders -Next to impossible to detect in toxicology tests

Trump signing Opioid bill: Changes Medicare & Medicaid

Expand Medicare coverage for opioid treatment, increase screenings for opioid use disorder and expand the use of tele-health services for the treatment of substance-use disorders.

Purdue Pharma 1995

FDA let Purdue Pharma to claim that Oxycontin's long-acting formulation was "believed to reduce" its appeal to drug abusers compared with shorter-acting painkillers like Percocet and Vicodin -Based on theory, not clinical trials -Became chief selling tool for OxyContin

Trump signing Opioid bill: Lifts treatment restrictions

Federal officials have sought for years to make it easier for doctors to prescribe drugs like Buprenorphine, which help people wean off their opioid addiction. The law allows clinical nurse specialists and others to prescribe those drugs for five years. -Physicians may prescribe those drugs for up to 275 patients, putting raising previous cap

opioid prescription stat

If the amount of opioids prescribed per year were averaged out across the US population, everyone would get about a 2-3 week supply :O

OxyContin abuse

In fact, drugs were being abused because they had far higher narcotic levels than standard, shorter-acting painkillers, and could be snorted or injected intravenously

Pharmaceutical Companies

In late 1990's, drug companies assured the medical community that patients would not become addicted to opioid pain relievers

Trump signing Opioid bill: Blocking mail order of illegal drugs

It will require the United States Postal Service to start collecting information on international mail shipments, just as private carriers like Fed Ex and DHL already have to do -By the end of this year, the Postal Service will need to provide the name and address of the sender and the contents of the package, as described by the sender, for at least 70 percent of all international packages, including all of those from China.

Methadone

Long-acting synthetic opioid agonist medication -prevents withdrawal symptoms, reduces craving, blocks the effects of illicit opioids, long history of use in treatment of opioid dependence in adults, taken orally (liquid, pill, or wafer form), carefully supervised

how Naltrexone is taken

Must be taken orally—either daily or three times a week -Noncompliance is a common problem -best suited for highly motivated, recently detoxified patients who desire total abstinence because of external circumstances—for instance, professionals or parolees. -Recently, a long-acting injectable version, called Vivitrol, was approved. -only needs to be delivered once a month can facilitate compliance

Trump signing Opioid bill: Improved access to treatment

One of the most expensive provisions will repeal an obscure rule that blocks states from spending federal Medicaid dollars on residential addiction treatment at centers with more than 16 beds -Originally meant to prevent warehousing of mentally ill

Over time, opioid users began moving to more potent kinds of opioids. why?

Particularly heroin and illicitly obtained fentanyl and its analogs -Some lost access to painkillers -Others just wanted to seek out a stronger high -Some illicit drugs cheaper than prescription drugs

With shift from prescription opioid medications to heroin and fentanyl, the crisis has also begun to afflict different people.

Prescription opioid overdose deaths have really hit middle-aged and older Americans in their 40s and up -Heroin and fentanyl are much more likely to hit younger adults in their 20s and early 30s

Reversing Overdose (Naloxone)

Rapidly reverses opioid overdose -Opioid antagonist-binds to opioid receptors and can reverse and block the effects of other opioids -Can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications. --One dose likely won't work for fentanyl --Administered by emergency medical personnel

Poly-substance use

Roughly half of heroin-related deaths involved alcohol -CDC found that 31% of prescription painkiller-linked overdose deaths in 2011 were also linked to benzodiazepines

Naltrexone

Synthetic opioid antagonist —it blocks opioids from binding to their receptors and thereby prevents their euphoric and other effects.

Buprenorphine

Synthetic opioid medication that acts as a partial agonist at opioid receptors —it does not produce the euphoria and sedation caused by heroin or other opioids but is able to reduce or eliminate withdrawal symptoms associated with opioid dependence and carries a low risk of overdose.

Fentanyl

Synthetic opioid used medically to relieve pain -First made in 1960s -Adopted as a spray, patch, lollipop, and other mediums for pain relief -On illicit market, fentanyl is really a category for several synthetic opioids that function similarly

Opioids solving doctors problems

Treating complex pain problems required training, time, and resources doctors didn't have -Quick, easy response was to give patients pills -Some times, doctors simply prescribed far too much.

Medical Assisted Treatment (MAT)

Use of medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders -Methadone -Buprenorphine -Naltrexone

Naltrexone use

Used for many years to reverse opioid overdose -Also approved for treating opioid addiction. -Based on theory that repeated absence of the desired effects of abusing opioids will gradually diminish craving and addiction. -It itself has no subjective effects following detoxification (that is, a person does not perceive any particular drug effect) -No potential for abuse -Not addictive.

when Naltrexone is prescribed

Usually in outpatient medical settings, although the treatment should begin after medical detoxification in a residential setting in order to prevent withdrawal symptoms.

Why don't we prescribe fewer opioids?

We have - reduction in prescriptions since 2010 -In 2015, the amount of opioids prescribed per person is still triple that of 1999

"Balloon Effect"

When a drug's supply is limited, users and traffickers don't give up; they instead find other ways to get their high. -It's like pushing down on a half-inflated balloon: The air doesn't vanish, but instead moves to another part of the balloon.

who has highest amount of overdose deaths?

Whites

doctors feeling pressure

by advocacy groups (some pharma-backed), medical associations, and government agencies to treat pain more seriously. -Also pressured to see patients quickly and efficiently

Suboxone

combines buprenorphine with the drug naloxone, an antagonist (or blocker) at opioid receptors

Methadone maintenance is more effective when

it includes individual and/or group counseling, with even better outcomes when patients are provided with, or referred to, other needed medical/psychiatric, psychological, and social ,services (e.g., employment or family services)

One of the things that makes fentanyl and its analogs so deadly

it's very often drug users don't seek them out -They think they're buying heroin that turns out to be fentanyl or at least laced with fentanyl or one of its analogs. -Someone will try the same dose of "heroin" he's always tried, only to end up overdosing because of the unexpected fentanyl

Purdue Pharma 1996

knew about "significant" abuse of OxyContin and concealed it -Pills were being crushed and snorted -Pills stolen from pharmacies -Doctors charged with selling prescriptions

Opioids are a vital component of :

modern medicine that have measurably improved the quality of life for millions of people, particularly cancer patients and those with *acute* pain -Efficacy in treating chronic pain is less clear, especially when weighed against the risks of overdose and addiction.

solving the opioid problem

requires controlling prescription opioid distribution while maintaining access for patients with legitimate medical needs -Suddenly removing access to opioids from those who are dependent on them to function could easily push people to illicit opioid sources, like heroin or counterfeit pills.

Naloxone has no effect when Suboxone is taken as prescribed, but if an addicted individual attempts to inject Suboxone.....

the naloxone will produce severe withdrawal symptoms. -Thus, this formulation lessens the likelihood that the drug will be abused or diverted to others

how was Purdue Pharma marketing their drug?

they continued to market OxyContin as less prone to abuse and addiction than other prescription opioids

Trump signing Opioid bill: Alternatives to opioids

would provide funds for researching and developing new nonaddictive painkillers. -It would also allow the FDA to require that certain opioids be dispensed in packaging that limits their abuse potential —for example, in blister packs that provide only a few days' supply.