Substance Use Disorder Effects & Resources

Transcription

1 CONQUERING THE CRISIS: FIGHTING SUBSTANCE MISUSE IN ALABAMA Substance Use Disorder Effects & Resources Lori Lioce, DNP, FNP-BC, FAANP The University of Alabama in Huntsville

2 DISCLOSURE/CONFLICT OF INTEREST Board of Directors, Not One More Alabama, Inc. Board of Trustees, Huntsville Hospital Foundation I have no financial conflict of interest in relation to this program.

3 OBJECTIVES Discuss personal, family, and societal effects of drug abuse Discuss resources available for those with a drug addiction/sud Describe the process for referring patients for drug abuse treatment Describe challenges and solutions for getting patients with drug addiction/sud treatment Dr. Lori Lioce 2/21/2019 3

4 SOCIETAL EFFECTS Theft/Law Enforcement Physical/Verbal Abuse Isolation/Homelessness

5 FAMILY EFFECTS Nuclear family Children compensate for parental deficiencies Single Parent with SUD: Children likely not age appropriate Aging parents: Inappropriately dependent relationships: Miss Launching Phase Extended Family Feelings of abandonment, anxiety, fear, anger, concern, embarrassment, or guilt May ignore or cut ties with the person abusing substances Seek legal protection Intergenerational effects: negative impact on role modeling, trust, and concepts of normative behavior: Damage the autonomous relationships between generations Neighbors Friends Co-workers Unreliable, decreased productivity = resentment Substance Abuse Treatment and Family Therapy (SMHSA)

6 FAMILY CHARACTERISTICS (TYPICALLY PRESENT) Negativism Parental inconsistency Parental Denial Miscarried expression of Anger Self-medication Unrealistic parental expectations (Reilly, 1992)

7 PERSONAL EFFECTS Overwhelming Shame Judgement Increasing Isolation Antisocial behavior: With others who abuse Debt Dr. Lori Lioce 2/21/2019 7

8 RESOURCES AVAILABLE FOR THOSE WITH A DRUG ADDICTION/SUD

9 OUR ROLE 1. Teach patients about the risks of opioid diversion and nonmedical use. 2. Educate patients on the risks of opioid diversion. 3. Provide controlled substance disposal education 4. Assess risk 5. Provide resources 6. Track opioid use

10 STRATEGIES 1. Prevention 2. Intervention 3. Treatment/Recovery 4. Enforcement

11 ASESSSMENT & READINESS CLINICAL PRACTICE MODEL Stage of Change (Prochaska & DiClemente) 1. Precontemplation 2. Contemplation (30-40% of addicted persons) 3. Preparation (10-15%) 4. Action (altered behavior for 1-6 months) 5. Maintenance (preventing relapse) Dr. Lori Lioce 2/21/

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13 REFERRING PATIENTS FOR DRUG ABUSE TREATMENT

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15 THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

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17 Support, Educate & Inspire those impacted by disease of addiction

18 PROGRAMS

19 AMERICAN SOCIETY FOR ADDICTION MANAGEMENT DOWNLOADABLE PATIENT POCKET GUIDE

20 CHALLENGES AND SOLUTIONS FOR GETTING PATIENTS WITH SUD TREATMENT

21 TYPICAL BARRIERS TO TREATMENT Not knowing what to signs or symptoms to look for Lack of script for discussion. Chemical changes in the brain Non-linear process

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26 DON T WAIT FOR ROCK BOTTOM tions/drugs-brains-behavior-scienceaddiction/drug-misuse-addiction

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28 FAMILY SUPPORT RESOURCES Separate 12-Step groups Al-Anon Alateen Co-Dependents Anonymous (CoDA) Adult Children of Alcoholics, (ACOA) Adult Children Anonymous Families Anonymous Co-Anon

29 DESTIGMATIZE TO IMPROVE TREATMENT Dr. Lori Lioce 2/21/

30 TREATMENT CONSIDERATIONS

31 CERTIFICATIONS Substance Abuse Nursing Specialty Certified Addictions Registered Nurse Substance Abuse Practitioner - Health Care Professionals seeking Certification as a Substance Abuse Practitioner. Addiction Counseling Competencies Substance Abuse & Mental Health Service Administration (SAMHSA)

32 RESOURCES Center on Addiction Partnership for Drug free Kids Addiction Prevention Coalition Addiction Policy Forum Shatterproof Center for Motivation & Change National Institute on Drug Abuse Not One More

33 DID YOU KNOW? Alabama Opioid Overdose and Addiction Council (formerly Governors Council) Alabama Office of Substance Abuse treatment Services (GRANT FUNDED SERVICES) Assessment tools & Billing Manual MedEd Portal Opioid Training Department of Public Health offers PEER SUPPORT SPECIALIST MUST BE IN RECOVERY

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36 PROVIDE DISPOSAL EDUCATION Disposal instructions are available at: local controlled substance disposal locations at

37 MAKE A DIFFERENCE AT EACH ENCOUNTER WITH PATIENTS Set expectations. Discuss alternatives. Lay out the risk of addiction. Review the unpleasant side effects. Teach the symptoms of overdose & addiction. Co-prescribe Narcan with repetitive Rx DISRUPT THE STATUS QUO!

38 EDUCATE PATIENTS AND FAMILIES TO AVOID OTCS

39 FUTURE CONSIDERATIONS Interprofessional communication for intervention. Save A life, call each other Refer to ADPH peer coaching; consider parent coaching Expansion of insurance coverage Strategies for friends of users Post NARCAN resuscitation: consider AUTOMATIC Protocol -may include initiation of MAT/withdrawal treatment so don t patient at less risk of overdose when they leave with symptoms from depletion of seratonin/dopamine. Patient leave with Narcan care kit.

40 REFERENCES Rudd RA, Seth P, David F, Scholl L. (2016). Increases in Drug and Opioid-Involved Overdose Deaths United States, MMWR Morb Mortal Wkly Rep. 2016;65. doi: /mmwr.mm655051e1. National Institutes of Health, (2018). HEAL Initiative Research Program. Morone NE, & Weiner DK. (2013). Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther. 2013;35(11): doi: /j.clinthera Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, & van der Goes DN. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4): doi: /01.j.pain f1. Muhuri PK, Gfroerer JC, & Davies MC. (2013). Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Rev. August Cicero TJ, Ellis MS, Surratt HL, & Kurtz SP. (2014). The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. 2014;71(7): doi: /jamapsychiatry Carlson RG, Nahhas RW, Martins SS, & Daniulaityte R. (2016). Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160: doi: /j.drugalcdep

41 REFERENCES Drug Abuse and Addiction. (n.d.). Hitting rock bottom? Resource loss as a predictor of alcoholism treatment completion. (n.d.). [link url=" type="ext"] Treatment, C. F. (n.d.). Conceptualizing Motivation And Change. Commonly Abused Drugs Charts. (2016). Alcohol's Effects on the Body. (n.d.). Principles of Effective Treatment. (n.d.).

42 TIPS Use the medication reconciliation process as an opportunity to educate your patients about issues like tolerance, physical dependence, opioid misuse, and drug diversion. Inform patients that sharing a prescription drug with another person is not only a federal crime according to the Controlled Substances Act, but could cause serious harm to a person who is using a medication without medical oversight. Don t fall into the trap of believing everyone already knows this. Educate yourself and your patients about ways to store controlled substances to prevent diversion, and how to properly dispose of any leftover medications that are no longer needed. Please be aware that flushing pills down a toilet or garbage disposal is no longer considered to be an environmentally sound practice. Consider taking a continuing education course that focuses on best prescribing and patient monitoring practices. Advocate for and support relevant policies at every level of government, from municipal to federal. i.e. expanded access to medication-assisted treatment (MAT) for addiction, interoperability between state-run electronic pharmaceutical databases, drug take-back programs, programs that address the psychosocial needs of those living with chronic pain, and policies regarding the responsible distribution of naloxone. American Sentinel (2016)

43 OPIOID ANTAGONIST HB208 was signed into law in 2015 and provided immunity for prescribing and administering an opioid antagonist, such as naloxone. This is commonly known as a "Good Samaritan Law". In 2016, HB379 was signed into law, providing the State Health Officer or a county health officer the authority to write a standing order for dispensing naloxone.

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45 NARCAN Standing Order RX for Patients or Families with anyone at risk for Misusing prescription opioids (like oxycodone) or using heroin or illicit synthetic opioids (like fentanyl or carfentanil). Having an opioid use disorder, especially those completing opioid detoxification or being discharged from treatment that does not include ongoing use of methadone, buprenorphine, or naltrexone. Being recently discharged from emergency medical care following an opioid overdose. Being recently released from incarceration with a history of opioid misuse or opioid use disorder. (Turning Hope into Action : Allen County Initiative, 2019)

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47 EDUCATIONAL & VIDEO RESOURCES Monitoring Future NIDA Dr. Nora Volkow Director NIDA 2017 Surgeon general's letter to clinicians in crusade against opioid abuse: Our Health Crisis (5 minutes) Prescription Opioids: Even When Prescribed by a Doctor The US Heroin Epidemic - Mike Young Not One More Illinois Medicine Abuse Project Greek Life Associated Binge Drinking Close to half of fraternity members report symptoms of alcohol use disorder at age 35 Dr. Lori Lioce 2/21/