Inspiring Health: Opioid Dependency

Opioid Dependency: Prevent, Detect, Conquer

Susan Conway, Pharm.D., BCPS

 

 

Opioids (AKA pain killers, narcotics)

·        Morphine (MS Contin), Oxycodone (OxyContin, Percocet), Hydrocodone (Norco),

Meperidine (Demerol), Oxymorphone (Opana), Fentanyl, Codeine

·        Slang:  Hillbilly heroin, oxy, OC, oxycotton, percs, happy pills, vikes, Captain Cody, Cody, schoolboy, M, Miss Emma, monkey, white stuff, Vike, Watson-387, juice, smack, D, footballs, dillies, biscuits, blue heaven, blues, Mrs. O, octagons, stop signs, O bomb

 

Facts and Figures

·        Taking prescription medications to get high can be as dangerous and addictive as using illicit drugs

·        24,000 opioid-related deaths in US each year with 50% from nonmedical use of prescription opioids

o   Notable examples

§  Prince 57, overdose with fentanyl

§  Austin Box, 22, overdose with 5 opiate pain meds and Xanax

·        1.5 million emergency room visits related to opioid intoxication

·        Oklahoma had the highest rates of nonmedical use of prescription opioids

·        Combining prescriptions drugs with other medications and/or alcohol increased the effects of each drug and the risk of overdose and death

·        Prescription opioids have been suggested to be an important gateway drug for addiction

·        This is a complex problem that has to be balanced with the fact that 110 million people in US suffer from chronic pain

 

Prevent

·        Risk factors for addiction

o   Exposure

o   Genetics 60-70%

o   Psychiatric disease

·        Risk factors for relapse

o   Stress

o   Exposure to conditioned cues related to past drug use

o   A dose of a previously used drug or a drug with similar properties

·        Safe practices in pain management

o   Consider non-opioid first

o   If opioid warranted, start with lowest effective dose and continue for shortest duration needed

o   Physician-patient contracts

o   Prescription monitoring programs to detect physician and pharmacy shopping

o   Urine drug toxicology screening

o   Avoid combining with other opioids or sedatives

o   Assess for family history of addiction -  Monitor closely and consider use of opioid formulations aimed at reducing abuse

o   Evaluate need for continued opioid use with each prescription

o   Screen for substance abuse and make referrals to addiction specialist as indicated

o   Do not replace lost, stolen, or destroyed meds

o   Educate patient on safe medication use

§  Appropriate medication usefor patient only

§  Secure storage to prevent theft by family/friends

§  Proper disposal of left over meds

 

 

Detect

·        Opioid effects: 

o   Mild: drowsiness, pupillary constrictions and slurred speech

o   Severe: respiratory depression, stupor, coma, and even death

·        Opioid withdrawal

o   Diarrhea, sweating, shivering, nausea, vomiting, sleeplessness, restlessness, tremors, bone pains, and diffuse muscle aches

·        If you suspect a friend or loved one has a substance abuse problem, ask the following:

o   Does the person take the drug in larger amounts or for longer than intended?

o   Do they want to cut down or stop using the drug but can’t?

o   Do they spend a lot of time getting, using, or recovering from the drug?

o   Are they unable to manage responsibilities at work, home, or school because of drug use?

o   Do they continue to use a drug, even when it causes problems in relationships?

o   Do they give up important social, recreational, or work-related activates because of drug use?

o   Do they use drugs again and again, even when it puts them in danger?

o   Do they continue to use, even while knowing that a physical or mental problem could have been caused by or made worse by a drug?

o   Have they developed withdrawal symptoms which can be relieved by taking more of the drug?

 

Conquer

·        Admitting the problem and seeking help is an important first step

·        What to do if you think your adult friend or loved one might be addicted

o   You cannot fix the problem yourself

o   Offer to walk them through the information and to help access resources

o   Seek help from church community

o   Use information to encourage them to seek help

§  If they are resistant to help, see if you can convince them to at least see a physician. https://asam.ps.membersuite.com/directory/SearchDirectory_Criteria.aspx

§  There is no evidence that interventions are effective.

§  There is a great deal of scientific evidence that treatment works and people recover everyday. 

o   Treatment centers vary in location or medical approach

§  Tailored to address drug abuse problems as well as other medical, psychiatric, and social problems

§  Outpatient and inpatient (residential)

§  Often include medication and behavioral therapy

§  Free tools help withresearching facilities including payment information:https://findtreatment.samhsa.gov/  or 1-800-662-HELP (4357)

o   Treatment methods

§  Opioid substitution with methadone or buprenorphine, followed by a gradual titration

§  Abrupt opioid discontinuation with the use of clonidine to suppress withdrawal symptoms

§  Clonidine-naltreone detoxification

o   Narcotics Anonymous (NA) based on a 12 step model – self-help groups are a great resource for support and encouraged during and after treatment