Drugs Exam 2

Percentage of parents who report they are at least moderate drinkers by gender and family type: 2001-2014

- single fathers drink the most -fathers in two-parent families drink 10% below single fathers

Social drivers

-"Historically, female addiction has been largely the result of inappropriate overmedication practices by physicians and pharmacists, media manipulation, or individuals own attempts to cope with social or occupational barriers preventing equality and self-fulfillment." Kandall, 2010

President Nixon continued

-"If we cannot destroy the drug menace in America, then it will surely in time destroy us," Nixon told Congress in 1971. "I am not prepared to accept this alternative." -Started a focused international effort- military based -Increased criminalization of drug use domestically- punitive measures were focus.

Racial injustice

-"The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people," former Nixon domestic policy chief John Ehrlichman told Harper's writer Dan Baum -"You understand what I'm saying? We knew we couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. "

Timeline

-1911 to 1990s >Opioid pain medications were used primarily for acute pain and cancer pain. Studies showing inadequate treatment of chronic non-cancer pain by physicians lead to an increased use of opioids. -1987 >May: MS Contin, (morphine sulfate) approved; first formulation of an opioid pain medicine that allowed dosing every 12 hours instead of every 4 to 6 hours. -1990 >August: Duragesic (fentanyl transdermal system) approved; first formulation of an opioid pain medicine in a patch (sometimes referred to as a "skin patch") that is changed every 3 days. -1995 >December: OxyContin (oxycodone controlled-release) approved; first formulation of oxycodone that allowed dosing every 12 hours instead of every 4 to 6 hours. OxyContin would soon become a focal point of opioid abuse issues that would continue to escalate into the late 2000s and beyond.

1970's-Domestic-DEA

-1973 the Drug Enforcement Agency (DEA) was created out of the merger of the Office for Drug Abuse Law Enforcement, the Bureau of Narcotics and Dangerous Drugs, and the Office of Narcotics Intelligence (1) It will put an end to the interagency rivalries (2) It will give the FBI its first significant role in drug enforcement by requiring that the DEA draw on the FBI's (3) The new DEA will provide a single focal point for coordinating Federal drug enforcement efforts with State and local authorities as well as with foreign police. -DEA began its work with 1,470 special agents and an annual budget of $74.9 million (FY1973). By 1975, these numbers grew to 2,135 special agents and an annual budget of $140.9 million (FY1975). In FY2014, the DEA had over 9,000 full time employees and its budget was approximately $2.0 billion.

1980's Domestic

-1980's defined by the crack and cocaine epidemics -When President Ronald Reagan took office in 1981, he vowed to crack down on substance abuse and reprioritize the War on Drugs, which was originally initiated by President Richard Nixon in the early 1970s. -1983, Los Angeles Police Chief Daryl Gates, who believed that "casual drug users should be taken out and shot," founded the DARE drug education program, which was quickly adopted nationwide despite the lack of evidence of its effectiveness.

Columbia's Cartels Continued

-1982: Panamanian leader Gen. Manuel Noriega allows Pablo Escobar to ship cocaine through Panama. In the United States, Vice-President George H.W. Bush combines agents from multiple agencies and military branches to form the South Florida Drug Task Force, Miami being the main entry point at the time. >In March, Pablo Escobar is elected to the Colombian congress; he gained support by building low-income housing, doling out money in Medellin slums and campaigning with Catholic priests. He's driven out of Congress the following year by Colombia's minister of justice. -1985: Colombia extradites drug traffickers to the United States for the first time. U.S. officials discover that the Medellin cartel has a "hit list" that includes embassy members, their families, U.S. businessmen and journalists.

1980's Just Say No

-1984: Nancy Reagan launches her "Just Say No" anti-drug campaign. -Media and political focus ramps up >In 1985, the proportion of Americans polled who saw drug abuse as the nation's "number one problem" was just 2-6%. The figure grew through the remainder of the 1980s until, in September 1989, it reached a remarkable 64%

William Bennett

-1989: President George H.W. Bush creates the Office of National Drug Control Policy (ONDCP) and appoints William Bennett as his first "drug czar." Bennett aims to make drug abuse socially unacceptable. -Responsible for ramping up efforts under the Bush Administration -In the drug war there are only "good guys" and "bad guys." -Set belief that the 'bad guys' are tens of millions of Americans-not only those who smuggle drugs and distribute them across the country but also those who use illegal substances of any kind and even those of us who look the other way.

Welfare and food stamps

-1996 welfare reform act barred felons with drug convictions from obtaining welfare — including participation in the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) — unless states actively waived those restrictions. -32 states ban anyone convicted of a drug felony from collecting food stamps -Increases stigma among welfare recipients -Increases recidivism among convicted drug sellers

War On Drugs- 2000's- A New Focus

-2003 April, the Illicit Drug Anti-Proliferation Act is enacted, which targets ecstasy, predatory drugs and methamphetamine. >shifted emphasis from punishing those who establish places where drugs are made, distributed, and consumed to those who knowingly maintain such places >more directly target the producers of raves where synthetic drugs such as MDMA were often used -2004: Along with the State Department and the Department of Defense, the DEA announces its involvement in the U.S. Embassy Kabul Counter narcotics Implementation Plan. It's designed to reduce heroin production in Afghanistan, the world's leading opium producer.

Cycles of poverty: Housing

-All applicants to and residents of housing assistance programs are subject to federal alcohol, drug, and criminal activity restrictions, intended to increase the safety of assisted housing and to award a scarce benefit to "deserving" applicants (HUD, 1996; McCarty et al., 2012). -Public housing authorities can evict tenants based on even minor evidence that criminal activity has occurred, regardless of whether someone in the household has been convicted of anything.

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-Allows federal agencies to pursue more research projects related to addiction and pain. -Helps Medicare/Medicaid to attempt to limit the over prescription of opioid painkillers and expand access to addiction treatment. -Advances new initiatives to educate and raise awareness about proper pain treatment among health care providers. -Attempts to improve coordination between different federal agencies to stop illicit drugs like fentanyl at the border, -Increases penalties for drug manufacturers and distributors related to the overprescribing of opioids. -Is it all tweaks and sweeping rather than inherent important changes -No major increase in funding

Support For Patients And Communities Act

-Bipartisan Effort >Became Law 10/24/18 -Reauthorizes funding from the Cures Act, which put $500 million a year toward the opioid crisis, and makes tweaks to hopefully give states more flexibility in using the funding. -Creates a grant program for "Comprehensive Opioid Recovery Centers," which will attempt to serve the addiction treatment and recovery needs of their communities (in part by using what's known as an ECHO model). -Lifts restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs. -Expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone

Naloxone

-Cant be abused -No effect in the absence of opioids -Restores breathing -Used for decades -Doesn't change behavior -Can be administered by laypeople -Does not permanently stop an overdose- CALL 911

Anti-Drug Abuse Act of 1988

-Created the policy goal of a drug-free America -Established the Office of National Drug Control Policy -The Act amended 21 U.S.C. 844 to make crack cocaine the only drug with a mandatory minimum penalty for a first offense of simple possession.

Central and South American Continued

-December 1989: the United States invades Panama. Gen. Manuel Noriega surrenders to the DEA on Jan. 3, 1990, in Panama and is sent to Miami the next day. In 1992, Noriega is convicted on eight counts of drug trafficking, money laundering and racketeering, and sentenced to 40 years in prison. -1991: The Colombian assembly votes to ban extradition in its new constitution. Pablo Escobar surrenders to the Colombian police the same day. He is confined in a private luxury prison, though reports suggest that he travels in and out as he pleases. When Colombian authorities try to move Escobar to another prison in July 1992, he escapes. -1992: Mexican President Carlos Salinas de Gortari issues regulations for DEA officers in his country. The new rules limit the number of agents in Mexico, deny them diplomatic immunity, prohibit them from carrying weapons, and designate certain cities in which they can live. -November 1993: President Clinton signs the North American Free Trade Agreement (NAFTA), which increases the amount of trade and traffic across the an border making it more difficult for U.S. Customs to find narcotics moving across the border.

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-December 1993: Pablo Escobar, in hiding since mid-1992, is found by Colombian police using American technology that can recognize his voice on a cell phone call and estimate his location. He tries to flee but is killed. -August 2000: President Bill Clinton gives $1.3 billion in aid to Plan Colombia, an effort to decrease the amount of cocaine produced in that nation. The aid supports the aerial spraying of coca crops with toxic herbicides, and also pays for combat helicopters and training for the Colombian military.

Treating Overdose

-Expand access to and use of naloxone - a non-addictive, life-saving drug that can reverse the effects of an opioid overdose when administered in time. -Access to naloxone can be expanded through: >Standing orders at pharmacies >Distribution through local, community-based organizations >Access and use by law enforcement officials >Training for basic emergency medical service staff on how to administer the drug

War On Drugs-International: Central and South America

-February 1987: In February, Carlos Lehder is captured by the Colombian National Police and extradited to the United States, where he's convicted of drug smuggling and sentenced to life in prison without parole, plus an additional 135 years. -May 1987: After receiving personal threats from drug traffickers, the justices on the Colombian Supreme Court rule by a vote of 13-12 to annul the extradition treaty with the United States. -1988: Carlos Salinas de Gortari is elected president of Mexico, and President-elect George H.W. Bush tells him he must demonstrate to the U.S. Congress that he is cooperating in the drug war. This process is called certification. -1989: Forbes magazine lists Pablo Escobar as the seventh-richest man in the world.

From your article

-First, many gay and transgender people live with a high level of stress that comes from social prejudice and discriminatory laws in areas of daily life such as employment, relationship recognition, and health care. -Second, a lack of cultural competency in the health care system discourages gay and transgender people from seeking treatment for substance abuse, and—if they do seek help—often leads to inappropriate or irrelevant services. -Finally, targeted marketing efforts by alcohol and tobacco companies exploit the connection many gay and transgender people have to bars and clubs as safe spaces for socializing and increase easy access to tobacco products and alcohol.

Opioid overdoses

-From 1999 to 2016, more than 630,000 people have died from a drug overdose. -Around 66% of the more than 63,600 drug overdose deaths in 2016 involved an opioid. -In 2016, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 5 times higher than in 1999. -On average, 115 Americans die every day from an opioid overdose.

Better Research

-HHS is supporting cutting edge research on pain and addiction to inform clinical practices, reduce opioid prescribing and combat the opioid crisis. -This research will help to ensure that policies are evidence-based and that patients are able to access the care they need.

Better Data

-HHS is supporting more timely, specific public health data and reporting, including through accelerating CDC's reporting of drug overdose data. -New tools -Enhanced surveillance -HHS Office of the Chief Technology Officer (CTO) held an unprecedented national opioids code-a-thon, bringing together 50 teams of data experts and computer scientists to derive insights and solutions for the epidemic from HHS data sets, some brought together for the very first time. -CMS released an updated version of the Medicare opioid prescription mapping tool.

Access: Better Prevention, Treatment, and Recovery Services

-HHS issued over $800 million in grants in 2017 to support treatment, prevention, and recovery, while making it easier for states to receive waivers to cover treatment through their Medicaid programs. 1. First Responders - provide training and medication for emergency treatment of opioid overdose. 2. State Pilot Grant for Treatment of Pregnant and Postpartum Women - support family-based services for pregnant and postpartum women with a primary diagnosis of a substance use disorder 3. Building Communities of Recovery - increase the availability of long-term recovery support for substance abuse and addiction.

Harm reduction

-Harm reduction is a set of ideas and interventions that seek to reduce the harms associated with both drug use and ineffective, racialized drug policies. -Harm reduction stands in stark contrast to a punitive approach to problematic drug use—it is based on acknowledging the dignity and humanity of people who use drugs and bringing them into a community of care in order to minimize negative consequences and promote optimal health and social inclusion.

Heroin continued

-Heroin is an illegal, highly addictive opioid drug. -A heroin overdose can cause slow and shallow breathing, coma, and death. -People often use heroin along with other drugs or alcohol. This practice is especially dangerous because it increases the risk of overdose. -When people inject heroin, they are at risk of serious, long-term viral infections such as HIV, Hepatitis C, and Hepatitis B -Heroin use has increased sharply across the United States among men and women, most age groups, and all income levels. >women, the privately insured, and people with higher incomes.

Heroin

-Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy -Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin -People inject, sniff, snort, or smoke heroin

Better Availability of Overdose-Reversing Drugs

-In April 2018, the Surgeon General released an Advisory on Naloxone (Narcan) and Opioid Overdose that emphasized the importance of access to naloxone for >patients currently taking high doses of opioids as prescribed for pain >individuals misusing prescription opioids >individuals using illicit opioids such as heroin or fentanyl >health care practitioners >family and friends of people who have an opioid use disorder, and >community members who come into contact with people at risk for opioid overdose.

Timeline- 2003

-January: FDA issued a Warning Letter (PDF - 149KB) to OxyContin's manufacturer, Purdue Pharma, for misleading advertisements. >Among many other details, the warning specified that the ads left out and minimized the serious safety risks associated with OxyContin and promoted it for uses beyond those which had been proven safe and effective. >Specifically, the letter pointed out that the advertisements failed to clearly present information from the product label's Boxed Warning regarding the potentially fatal risks and the danger of abuse.

President Nixon

-July 14, 1969: In a special message to Congress, President Richard Nixon identifies drug abuse as "a serious national threat." Citing a dramatic jump in drug-related juvenile arrests and street crime between 1960 and 1967, Nixon calls for a national anti-drug policy at the state and federal level. -Comprehensive Drug Abuse Prevention and Control Act of 1970 -June 1971 when U.S. Pres. Richard Nixon declared drug abuse to be "public enemy number one" and increased federal funding for drug-control agencies and drug-treatment efforts.

LGBTQ+ youth and SDH

-LGBT youth experience homelessness at a disproportionate rate. Studies indicate that LGBT youth are 120% more likely to experience homelessness. -LGBT homeless youth are more likely than their homeless heterosexual counterparts to have poorer mental and physical health outcomes, including major depressive disorders, PTSD and substance abuse (Keuroghlian, Shtasel, & Bassuk, 2014). -Becoming homeless is also related to future depressive and anxiety symptoms, disorderly conduct and substance use disorders, which highlights the long-term impact of unstable housing on LGBT homeless youth (Rosario, Scrimshaw, & Hunter, 2012). -LGBT homeless youth are 62 percent more likely to attempt suicide than their heterosexual counterparts, and they are at greater risk for sexual abuse, exploitation, sexual violence and drug abuse (National Alliance to End Homelessness, 2009). -The three most common reasons cited among LGBT youth for becoming homeless are (a) running away from families who reject them because of their sexual orientation or gender identity; (b) being forced out of their homes after disclosing their identities; and (c) aging out of or running away from the foster care system and the possible violence toward LGBT youth that can occur there (Keuroghlian et al., 2014).

Social determinants of health (LGBTQ+)

-Low-income LGBT individuals and same-sex/gender couples have been found more likely to receive cash assistance and food stamps benefits compared to heterosexual individuals or couples. -Among women 18-44 years of age, 29 percent of bisexual women and 23 percent of lesbians are living in poverty, compared to 21 percent of their heterosexual counterparts. -20 percent of gay men and 25 percent of bisexual men 18-44 years of age are living at or below the federal level of poverty, compared to 15 percent of heterosexual men. -A study of transgender adults in the United States found that participants were nearly 4 times more likely to have a household income of less than $10,000 per year compared to the general population.

Prescription opioids continued...

-More than 191 million opioid prescriptions were dispensed to American patients in 2017—with wide variation across states. -There is a wide variation of opioid prescription rates across states. Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. -Studies suggest that regional variation in use of prescription opioids cannot be explained by the underlying health status of the population

Native Americans: Nuclear waste and uranium mining

-Nevadans and Utahans living downwind and downstream from nuclear weapons testing, uranium mining and radioactive waste dumping have suffered immensely during the nuclear age -but even in the "nuclear sacrifice zones" of the desert Southwest, it is native Americans, from Navajo uranium miners to tribal communities targeted with atomic waste dumps, who have borne the brunt of both the from and back ends of the nuclear fuel cycle.

War On Drugs-International: Columbia's Cartels

-November 1975: Colombian police seize 600 kilograms of cocaine (the largest seizure to date) from a small plane. Drug traffickers respond with a vendetta, killing 40 people in one weekend in what's known as the "Medellin Massacre." The event signals the new power of Colombia's cocaine industry, headquartered in Medellin. -1979: Carlos Lehder, co-founder of the Medellin cartel, purchases a 165-acre island in the Bahamas. Small planes transporting drugs from Colombia to the United States use the island to refuel. Operations continue on the island until 1983. -1981: The Medellin cartel rises to power. The alliance includes the Ochoa family, Pablo Escobar, Carolos Lehder and Jose Gonzalo Rodriguez Gacha. The drug kingpins work together to manufacture, transport and market cocaine. The United States and Colombia ratify a bilateral extradition treaty.

A New Focus Continued

-Obama: >reduced the crack/powder sentencing disparity, >ending the ban on federal funding for syringe access programs >ended federal interference with state medical marijuana laws >did not shift the majority of drug policy funding to a health-based approach. -Synthetics: >Temporary scheduling of synthetic drugs has been a key tool in combating the onset of new synthetic drugs (2 years)

Anti-Drug Abuse Act of 1986

-October 1986: Reagan signs the Anti-Drug Abuse Act of 1986, which appropriates $1.7 billion to fight the drug war. -Along with the Comprehensive Crime Control Act of 1984, the act substantially increased the number of drug offenses with mandatory minimum sentences. (Move from rehabilitation to punishment) -Leads to racial inequities in the prison population because of the differences in sentencing for crack and powder cocaine. Possession of crack, which is cheaper, results in a harsher sentence; the majority of crack users are lower income >5 years without parole for possession of 5 grams of crack cocaine while it mandated the same for possession of 500 grams of powder cocaine. -The law led to an increase in average time imprisoned for drug crimes from 22 months to 33 months

Education

-Passed by Congress in 1998, the Higher Education Act delays or denies federal financial aid to anyone ever convicted of a felony or misdemeanor drug offense - including marijuana possession. -More than 200,000 people have been denied federal education assistance due to a past drug conviction according to the United States Government Accountability Office. This number does not account for persons who did not apply because they thought that they would be denied

Fentanyl

-Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain. -It is 50 to 100 times more potent than morphine. -It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the United States. -Recent cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally made fentanyl. -It is sold through illegal drug markets for its heroin-like effect. It is often mixed with heroin and/or cocaine as a combination product—with or without the user's knowledge—to increase its euphoric effects.

Prevent opioid use disorder

-Prescription drug monitoring programs -State prescription drug laws -Formulary management strategies in insurance programs, such as prior authorization, quantity limits, and drug utilization review -Academic detailing to educate providers about opioid prescribing guidelines and facilitating conversations with patients about the risks and benefits of pain treatment options

Prescription opioids

-Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer. -Dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.

Better Pain Management

-Promotes healthy, evidence-based methods of pain management. -Determining whether there are gaps or inconsistencies in pain management best practices among federal agencies. -Proposing recommendations on addressing gaps or inconsistencies.

1990's Violent crime control and law enforcement act of 1994

-Provisions implemented many things including money to hire 100,000 new police officers, $9.7bn in funding for prisons, and an expansion of death penalty-eligible offences. It also dedicated $6.1bn to prevention programs "designed with significant input from experienced police officers", however, the bulk of the funds were dedicated to measures that are seen as punitive rather than rehabilitative or preventative. -The bill included a federal "three-strikes" provision which required mandatory life imprisonment without possibility of parole for those who commit federal violent felonies if they had two or more previous convictions for violent felonies or drug trafficking crimes. -Was not 'the cause' of mass incarceration but continued the trend and solidified the 'tough on crime' outlook in the USA

Prevent opioid use disorder continued

-Quality improvement programs in health care systems to increase implementation of recommended prescribing practices -Improve awareness and share resources about the risks of prescription opioids, and the cost of overdose on patients and families. -Patient education on the safe storage and disposal of prescription opioids

Timeline- Early 2005

-Reports of overdose and death from prescription drug products, especially opioids, began to rise sharply, with OxyContin at the center of the problem. -By 2009, about 1.2 million emergency department (ED) visits were related to misuse or abuse of pharmaceuticals, an increase of more than 98% since 2004 and more than the number of ED visits related to use of illicit drugs such as heroin and cocaine. Most prominent among these prescription drug-related deaths and ED visits were opioid pain relievers (OPR), especially OxyContin. -FDA had worked with sponsors for more than a decade to implement risk management programs for a number of opioid products. However, data demonstrated that these programs did not adequately manage the risks of misuse, abuse, addiction, and overdose.

Basic stats for prescription patients

-Roughly 21 to 29% of patients prescribed opioids for chronic pain misuse them. -Between 8 and 12% develop an opioid use disorder. -About 4 to 6% who misuse prescription opioids transition to heroin. -80% of people who use heroin first misused prescription opioids. -Opioid overdoses increased 30% from July 2016 through September 2017 in 52 areas in 45 states. -The Midwest opioid overdoses increase 70% from July 2016 through September 2017. -Opioid overdoses in large cities increase by 54% in 16 states.

LGBTQ+ and drug misuse

-Sexual minorities use any illicit drug more than sexual majority -sex and gender don't make a difference -age doesn't make a difference

SDH- Discrimination

-Studies have shown that 42 percent to 68 percent of LGBT individuals report experiencing employment discrimination (Badgett, 2012; Fassinger, 2007). -In one study, 90 percent of surveyed transgender respondents reported experiencing harassment, mistreatment or discrimination at work due to their gender identity (Grant et al., 2011). -47 percent of transgender individuals also reported being discriminated against in hiring, firing, and promotion; over 25 percent reported they had lost a job due to discrimination on the basis of their gender identity (Grant et al., 2011). -In many cases, discrimination against and unfair treatment of LGBT persons remains legally permitted.

In combination

-Taking too many prescription opioids can stop a person's breathing—leading to death. -Prescription opioid overdose deaths also often involve benzodiazepines. Benzodiazepines are central nervous system depressants used to sedate, induce sleep, prevent seizures, and relieve anxiety. >alprazolam (Xanax®) >diazepam (Valium®) >lorazepam (Ativan®).

Drug testing poor people

-Temporary Assistance for Needy Families (TANF) -13 states tested 2,826 people out of about 250,000 applicants and recipients in 2016. >369 came back positive. -In four states, drug testing uncovered exactly zero positive tests for the whole year. -The positive drug test rate out of all applicants, in states where people tested positive, ranged from 0.07 percent in Arkansas to 2.14 percent in Utah -None of them came anywhere close to the national drug use rate of 9.4 percent for the general population.

Social Economic Model

-The Social Ecological Model (SEM) is a theory: based framework for understanding the multifaceted and interactive effects of personal and environmental factors that determine behaviors, and for identifying behavioral and organizational leverage points and intermediaries for health promotion within organizations. -individual, interpersonal, institutional, community, policy

New parents and drinking

-The survey found that more women admitted to drinking more after their first child was born, with 22% saying they increased their alcohol intake. -Fathers drink more frequently with 40% saying they drank a few times a week, compared to 28% of mothers and 13% of new fathers admitted to drinking every day, compared to 4% of mothers.

Price promotion, retail, and point-of-sale advertising

-Tobacco companies use price promotions used by African Americans and other minority groups, women, and young people: to increase sales. -Areas with large racial/ethnic minority populations tend to have more tobacco retailers located within them, -Menthol products are given more shelf space in retail outlets within African American and other minority neighborhoods

Opioid side effects-When taken as directed

-Tolerance: meaning you might need to take more of the medication for the same pain relief -Physical dependence: meaning you have symptoms of withdrawal when the medication is stopped -Increased sensitivity to pain -Constipation -Nausea, vomiting, and dry mouth -Sleepiness and dizziness -Confusion -Depression -Low levels of testosterone that can result in lower sex drive, energy, and strength -Itching and sweating

War On Drugs

-War on drugs is a series of actions tending toward a prohibition of illegal drug trade. It is a campaign adopted by the U.S. government along with the foreign military aid, military intervention and with the assistance of participating countries, to both define and to end the import, manufacture, sale, and use of illegal drugs. > Drug prohibition (domestic front), military aid (foreign policy and provides tools to other countries), military intervention (foreign policy, what we see along to boarder) > two focuses: demand reduction (not using drugs), and supply reduction (stopping the selling, production and importation of drugs)

Women and discrimination

-Women Earn 79 Cents To A Man's Dollar -Arguably the most known statistic for gender inequality, this number varies significantly based on race. -Poverty rates of women is higher than men -Poverty is compounded in single parent household which are more likely headed by women -46% of women believe they have experienced gender discrimination in the workplace(McCain Nelson, 2013).

Women and the SDH

-Women Earn 79 Cents To A Man's Dollar- Arguably the most known statistic for gender inequality, this number varies significantly based on race. -10 million women a year are victims of domestic violence -In the U.S., one in three women experience some form of contact sexual violence in their lifetime -Social pressure: *Family *Work *Appearance -Political power

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-Women may be more likely to go to the emergency room or die from overdose or other effects of certain substances. -Women who are victims of domestic violence are at increased risk of substance use. -Divorce, loss of child custody, or the death of a partner or child can trigger women's substance use or other mental health disorders. -Women who use certain substances may be more likely to have panic attacks, anxiety, or depression.

Women and drug use

-Women often use substances differently than men, such as using smaller amounts of certain drugs for less time before they become addicted. -Women can respond to substances differently. For example, they may have more drug cravings and may be more likely to relapse after treatment. -Sex hormones can make women more sensitive than men to the effects of some drugs. -Women who use drugs may also experience more physical effects on their heart and blood vessels. -Brain changes in women who use drugs can be different from those in men

4. Health Services (10%)

-access to health care -insurance -health care quality

Alcohol in college

-alcohol use in college students is higher than in their non-college peers

3. Social/Economic Environments (40%)

-attitudes -culture -race/ethnicity -gender -socioeconomic standing/status -education -living standards

5 areas of SDOH

-biology and genetics -individual behavior -social/economic environments -physical environments -health services

Social determinants of health

-conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks -this also includes the systems in place to offer health care and services to a community. These in turn shape: economics, social politics and politics

Secure medicine return program

-consumers have leftover, unwanted, or expired medicines in their home -consumers take unused medicine to secure drop boxes -drop boxes are located at pharmacies, hospitals, and police stations -approved and secured transporters pick up the medicines from drop boxes and deliver them to disposal facilities -properly permitted, high temp. inclination facilities dispose of waste medicines

Homelessness

-correlation between the factors that cause both poverty and addiction -mental illness, substance abuse, HIV/AIDS, veterans, domestic abuse victims, chronically homeless

Taxpayer money

-cost >$58 billion per year >totals= 1 trillion

Semi-synthetic opioid analgesics

-drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone; -Methadone, a synthetic opioid; -Synthetic opioid analgesics other than methadone, including drugs such as tramadol and fentanyl.

Disenfranchisement

-if convicted for a felony, you lose the right to vote -removed political voice from the community

Synthetic drugs in college

-lower use

Marijuana in college

-marijuana use is lower in college students than in their non-college peers -vaping marijuana is similar ^^

Vicodin in college

-misuse of Vicodin has dropped dramatically since 2009 in both groups

Nicotine in college

-nicotine is lower in college than non-college students

Methanol cigarettes advertising

-promotion of menthol cigarettes have been targeted heavily toward African Americans through culturally tailored advertising images and messages. -Nearly 9 of every 10 African American smokers (88.5%) aged 12 years and older prefer menthol cigarettes. -Menthol in cigarettes is thought to make harmful chemicals more easily absorbed in the body -menthol cigarettes may be more addictive than non-menthol cigarettes

2. Individual behavior (30%)

-risky or protective behavior *alcohol/drug use *vaccination *diet *physical activity -responses to health problems -care seeking -pain relievers -medical compliance

1. Biology and genetics (10%)

-sex -age -height -fitness -genetic factors

Sex/gender

-sex differences result from biological factors, such as sex chromosomes and hormones -gender differences are based on culturally defined roles for men and women, as well as those who do not identify with either category

Why we look at specific populations?

-social determinants of health -understand motivations -understand pressures -which drugs are misused and why? -how to respond

Population analysis must be intersectional

-the complex, cumulative manner in which the effects of different forms of identity and discrimination combine, overlap, or intersect

Minority stress

-the negative effects associated with the adverse social conditions experienced by individuals of a marginalized social group -Minority stress theory proposes that sexual minority health disparities can be explained in large part by stressors induced by a hostile, in this example homophobic culture, which often results in a lifetime of harassment, maltreatment, discrimination and victimization (Marshal et al., 2008; Meyer, 2003) and may ultimately impact access to care. -Theory can be applied to other minority groups- sex, religion race...

Targeted marketing

-the tobacco industry's attempts to maintain a positive image among African Americans have included such efforts as supporting cultural events and making contributions to minority higher education institutions, elected officials, civic and community organizations, and programs. -Tobacco companies have historically placed larger amounts of advertising in African American publications, exposing African Americans to more cigarette ads than Whites.

African Americans and Tobacco

-tobacco use is a major contributor to the three leading causes of death among African Americans (heart disease, cancer, and stroke) *Diabetes is the fourth leading cause of death among African Americans, the risk of developing diabetes is 30-40% higher for cigarette smokers than nonsmokers -African American children and adults are more likely to be exposed to secondhand smoke than any other racial or ethnic group -most African American adult cigarette smokers want to quit smoking and many have tried -Despite more quit attempts, African Americans are less successful at quitting than White and Hispanic cigarette smokers, possibly because of lower utilization of cessation treatments such as counseling and medication

5. Physical Environment (10%)

-water quality -air quality -climate and geography -built environment -food safety -land and soil quality

Mental health histories of methadone clinic participants by gender

-women using heroin or other types of opioids have a much higher percent of sexual abuse, physical abuse, mental abuse, self injury, suicide, depression, anxiety, etc.

CDC Plan on Overdose Prevention

1. Building prevention efforts by equipping states with resources, improving data collection, and supporting the use of evidence-based prevention strategies. 2. Improving data quality and tracking trends to better understand and respond to the epidemic. Supporting healthcare providers and health systems with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety. 3. Partnering with public safety officials, including law enforcement, to address the growing illicit opioid problem. 4. Encouraging consumers to make safe choices about opioids and raising awareness about prescription opioid misuse and overdose.

Health and human services

1. better addiction prevention, treatment, and recovery services 2. better data 3. better pain management 4. better targeting of overdose reversing drugs 5. better research

Risk factors for prescriptions

1. overlapping prescriptions 2. having a mental illness or a history of alcohol or other substance abuse 3. taking high daily dosages of prescription opioid pain relievers 4. living in rural areas and having low income -Inappropriate prescribing practices and opioid prescribing rates are substantially higher among Medicaid patients than among privately insured patients

Review of theory

1. perceived norms 2. social learning theories: we learn our patterns of behavior from those around us (family, peer groups) 3. structural influence theory: (macro) structural organization of a society, peer group or subculture as a main driver of drug use *subculture *social flux/disorganization: social strain *control theory: people left without bonds to other groups/society are at an increased risk for drug misuse

12 points to Improve Opioid Prescribing (1-3)

1.OPIOIDS ARE NOT FIRST-LINE THERAPY -Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient 2. ESTABLISH GOALS FOR PAIN AND FUNCTION -Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. 3. DISCUSS RISKS AND BENEFITS -Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy.

(10-12)

10. USE URINE DRUG TESTING -When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs. 11. AVOID CONCURRENT OPIOID AND BENZODIAZEPINE PRESCRIBING -Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible 12. OFFER TREATMENT FOR OPIOID USE DISORDER -Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.

continued...

4. Improving Access to Overdose Treatment - expand access to FDA-approved drugs or devices for emergency treatment of opioid overdose. 5. Targeted Capacity Expansion: Medication Assisted Treatment (MAT) expand access to medication-assisted treatment for persons with an opioid use disorder seeking treatment. 6. Services Grant Program for Residential Treatment for Pregnant and Postpartum - expand services for women and their children in residential substance abuse treatment facilities, among other services.

(4-6)

4. USE IMMEDIATE-RELEASE OPIOIDS WHEN STARTING -When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long- acting (ER/LA) opioids. 5. USE THE LOWEST EFFECTIVE DOSE -When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day 6. PRESCRIBE SHORT DURATIONS FOR ACUTE PAIN -When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed

(7-9)

7. EVALUATE BENEFITS AND HARMS FREQUENTLY -Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation 8. USE STRATEGIES TO MITIGATE RISK -Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms. Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present. 9. REVIEW PDMP DATA -Clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose.

Most opioid deaths occur where?

Northeast

Macro/policy level

advertisements and marketing, policy related to alcohol use, etc.

Community

community norms and attitudes regarding alcohol use, cultural norms, gender norms, etc

Microsystem

family and home environment, work-peer networks, peer support, family support, parental monitoring, parental alcohol use, etc.

Natural opioid analgesics

morphine and codeine

Individual

race/ethnicity, immigration status, SES etc.