OPIOIDS AND CHRONIC PAIN. Paul Snyder MA, LADC - S
|
|
- Drusilla Warner
- 5 years ago
- Views:
Transcription
1 OPIOIDS AND CHRONIC PAIN Paul Snyder MA, LADC - S
2 PAIN AS THE FIFTH VITAL SIGN 1996 Purdue Pharmaceuticals financed Pain as the Fifth Vital Sign campaign to help in the marketing of Oxycontin. (blood pressure, pulse, temperature, and respiratory rate) Addition of pain as a vital sign approved by the Joint Commission on Accreditation of Healthcare Organizations in 2000.
3 UNITED STATES LIKES PAIN PILLS The U.S. equals 4.6% of the world population and consumes: Over 90% of the global opioid supply 95% of the Hydrocodone produced There is no ceiling for opioids.
4 RX DRUG USE AN EPIDEMIC Prescription drug abuse is the nation's fastest-growing drug problem White House Office on National Drug Policy 1.3 million emergency room visits in 2010, a 115% increase since 2004 Overdose deaths on opioid pain relievers surpassed deaths from heroin and cocaine for the first time in 2008
5
6 THE RX NATION Every day 2,700 teens try a prescription drug to get high for the first time Partnership for Drug Free America, 2010 In 2010, nearly 60 percent of the drug overdose deaths (22,134) involved pharmaceutical drugs Opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths (16,651), confirming the predominant role opioid analgesics play in drug overdose deaths Last update February 20, 2013, content source Centers for Disease Control and Prevention
7 OPIOIDS DRIVE CONTINUED INCREASE IN DRUG OVERDOSE DEATHS Drug overdose deaths increase for 11th consecutive year 6,100 in ,849 in 1999 (4,030 opioid analgesics) 36,500 in ,329 in 2010 (16,651 opioid analgesics) 43,982 in 2013 (16,235 opioid analgesics) 47,055 in 2014 (18, 893 opioid analgesics) In 2012 the number-one cause of death in 17 US states was prescription drug abuse (Source:American Society of Interventional Pain Physicians)
8 MORE PEOPLE ARE DYING FROM DRUG OVERDOSES THAN FROM ANY OTHER CAUSE OF INJURY DEATH, INCLUDING TRAFFIC ACCIDENTS, FALLS OR GUNS Drug overdoses were responsible for 43,982 in ,663 (81%) of which were unintentional That's a rate of 120 every day (45 per day for Rx pain relievers) 6,748 people treated every day for the misuse or abuse of drugs In comparison, in 2010: 33,687 deaths from traffic accidents 31,672 people from firearms 26,852 died as a result of falling Centers for Disease Control, 2015
9 ACCIDENTAL RX OVERDOSES
10 HYDROCODONE
11
12 OXYCODONE OxyContin most recognized and abused form Prescribed to relieve pain Twice as strong as morphine Time released (8-12 hours) Pills crushed and snorted or cooked down and injected to break down time release component Strong, heroin-like, euphoric effects Expensive Other variations: Percocet and Percodan
13 OXYMORPHONE OPANA Powerful semi-synthetic opioid analgesic (painkiller) $25-$30 a pill Doctors begin prescribing it over OxyContin Injecting Opana according to FDA abuse deterrent coating makes it easier to inject Increased HIV/AIDS cases as a result You Tube: OP Microwave Method
14 ZOHYDRO ER, FDA APPROVED High dose hydrocodone narcotic painkiller Zohydro contains as much as 50 mg of hydrocodone Manufactured as a powder in a capsule, rather than a pill easy to abuse 10 times more powerful than Vicodin US presently consumes 99% of worlds hydrocodone
15 NATIONAL INSTITUTE ON DRUG ABUSE(NIDA) 2015 The number of prescriptions written for opioid pain relievers in the U.S. has risen from around 76 million a year in 1991 to nearly 207 million a year in In August, 2015, the FDA granted approval to Purdue Pharma to prescribe Oxycontin for patients as young as 11.
16 HEROIN Pure heroin is a white powder with a bitter taste that predominantly originates in South America, Afghanistan and Southeast Asia South American heroin has become the most prevalent type available in the US Particularly in the Northeast, South and Midwest Black tar heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River Dark color from crude processing methods leaving behind impurities
17 $$$$ STREET VALUE $$$$$ Oxycodone cost up to $1.00 a mg Percocet about $8 a pill Valium about $7 a pill Vicodin about $7 a pill Methadone $10 per dose Fentanyl $65 a patch Heroin $15 per bag (1/10 of a gram) Source: Nevada HIDTA (High Intensity Drug Trafficking Areas)
18 PRESCRIBING FOR PAIN START LOW AND GO SLOW CDC new opioid prescribing guidelines: Initially try nondrug interventions (cognitive behavioral therapy or exercise) or nonopioid medications (anti-inflammatories). If opioids are used, prescribe the lowest effective dose and start with immediate-release opioids instead of extended-release opioids. Only provide the quantity needed for the expected duration of the pain. Monitor patients regularly to make sure opioids are improving pain without causing harm. These recommendation are not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.
19 HEALTHY ALTERNATIVE TREATMENT Mel Pohl, MD, Medical Director for Las Vegas Recovery Center specializes in chronic pain and addiction Recommends distraction, yoga, massage, Reiki, mindfulness, meditation, food: Eat foods that reduces inflammation and avoid foods that increases inflammation. Cherries, blueberries, cranberries, blackberries contain anthocyanins which relieve pain more than aspirin.
20 DIET Vitamin C, used by the body to build and repair joint cartilage (good for people with osteoarthritis joint pain) Vitamin C, antioxidant which can reduce CRP C-reactive protein (CRP) clinical marker for inflamation Olive Oil, contains oleocanthol which interferes with COX 1 and COX -2 enzymes Omega 3 fatty acids (salmon, sardines, trout) are potent antiinflammatory agents H2O 8 to 10 glasses a day helps kidney and liver filter toxins and dilutes toxin concentrations in the blood which reduces inflammatory effects.
21 SUGAR BAD CANDY BAD SODA BAD BAKED GOODS BAD ALCOHOL - BAD All cause the body to produce Advanced Glycation End products (AGE s) which trigger massive amounts of inflammation Foods with high glycemic index simple carbohydrates white bread, white rice, are quickly converted to glucose during digestion Alcohol is: converted into sugar almost immediately; and irritates intestinal tissue and allows bacteria to pass into the blood more readily. The presence of bacteria will increase inflammation.
22 OPIOID MAINTENANCE More than one-half of patients who receive continuous opioid therapy for 90 days are still receiving opioids more than four years later. The benefits of short-term opioid therapy is supported by multiple clinical trials. However, the benefit of opioids for managing chronis pain is limited. Chronic visceral or central pain syndromes (e.g. abdominal or pelvic pain, irritable bowel syndrome, fibromyalgia, headache, neuropathic pain) may be especially unresponsive to long-term opioid therapy. American Family Physician: Weighing the Risks and Benefits of Chronic Opioid Therapy, Anna Lembke et al. Stanford University School of Medicine
23 OPIOID MAINTENANCE Furthermore, the risks associated with chronic opioid therapy increases in a dose-dependent manner. Patients at increased risk of over-dose include those with medical comorbidities(e.g. sleep apnea, lung disease, heart failure); those reeiving benzodiazepines or other sedative-hypnotics; those with problematic alcohol use; and those with psychiatric comorbidities (e.g., depression) American Family Physician: Weighing the Risks and Benefits of Chronic Opioid Therapy, Anna Lembke et al. Stanford University School of Medicine
24 WORKING WITH PATIENTS Discussing why you don t want to provide another opioid prescription after the patient is accustomed to them. Takes time there goes your lunch break. Makes the patient upset. Possible complaint there goes the bonus. Possible lost patient.
25 6 MINUTE TALK Define What Success Looks Like Agree On An Exit Strategy
26 TREATMENT Addiction is a chronic disease which can be managed, but not cured. How do you manage it? Possible medication Counseling Support family and friends
27 STAFF COMPLEX CASES You are not alone! Other providers add insights for optimal care Qualified expert physicians give different perspectives to medication management A diverse group of professionals helps the doctor make the correct decision Time limited staffing weekly or monthly
28 MEDICATION Methadone Full agonist at the mu opioid receptor, has street $ value, possible overdose, can change cardiac electrical conduction producing prolonged QTc interval, continuous dosing (years), Buprenorphine Partial agonist at the mu opioid receptor and a partial antagonist at the cappa opioid receptor, will displace other opioids on receptor causing withdrawal, Has street value, can titrate down quickly Naltrexone 28 day Mu receptor coverage, no street value
29 COUNSELING Cognitive Behavioral Therapy (CBT) Is a wellestablished treatment for pain that involves helping the person improve coping skills, address negative thoughts and emotions that can amplify pain, and learn relaxation methods to help prepare for and cope with pain. It is used for chronic pain, postoperative pain, cancer pain, and the pain of childbirth. Many clinical studies provide evidence for the effectiveness of this form of treatment in pain management. Defined by the National Institute of Health
30 NIH ON COUNSELING Counseling can give an individual suffering from pain much needed support, whether it comes from family, group, or individual counseling. Support groups can provide an important supplement to drug or surgical treatment. Psychological treatment can also help people learn about the physiological changes produced by pain. Distraction, coping with triggers, music therapy, art therapy, mindfulness, yoga, massage, physical therapy, psychoeducation, mind body connection, visioning, support Provide coping skills and self empowerment to heal spiritually, emotionally, mentally and physically
31 SUPPORT FAMILY AND FRIENDS Education Communication Care for the family
32 CONTACT Paul Snyder MA, LADC-S
33 THE ELEVEN SYMPTOMS OF OPIOID USE DISORDER 1. Opioids are often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use. 3. A great deal of time is spent in activities necessary to obtain opioids, use opioids, or recover from its effects. 4. Craving, or a strong desire or urge to use opioids. 5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. 7. Important social, occupational, or recreational activities are given up or reduced because of opioid use. 8. Recurrent opioid use in situations in which it is physically hazardous. 9. Opioid use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids. 10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of opioids to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of opioids.
34 11. WITHDRAWAL, AS MANIFESTED BY THREE (OR MORE) OF THE FOLLOWING: Presence of either of the following: Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer). Administration of an opioid antagonist after a period of opioid use. Three (or more) of the following developing within minutes to several days after Criterion A: Dysphoric mood. Nausea or vomiting. Muscle aches. Lacrimination or rhinorrhea. Pupillary dilation, piloerection, or sweating. Diarrhea. Yawning. Fever. Insomnia. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
35 POST TEST QUESTIONS Can you identify a patient at risk of opioid misuse? Can you name two alternative methods for treatment of chronic pain other than opioids? Can you identify two foods that cause inflammation? Can you identify two anti-inflammatory foods? Do you have a standing operating procedure for prescribing opioids? Do you have a contract for patients to whom you prescribe opioids? Do you talk to your patient about an exit strategy prior to prescribing an opioid?
ECHO: ADDICTION AND CHRONIC PAIN. Paul Snyder MA, LADC - S
ECHO: ADDICTION AND CHRONIC PAIN Paul Snyder MA, LADC - S NATIONAL INSTITUTE OF DRUG ABUSE: The essence of addiction is the uncontrollable, compulsive drug seeking and use, even in the face of negative
More informationECHO: Healthy Alternatives for Pain Management. and AB 474 Compliance Check lists
ECHO: Healthy Alternatives for Pain Management and AB 474 Compliance Check lists BEFORE I CAN WRITE AN INITIAL PRESCRIPTION Have I established a bona fide relationship with the patient? Have I established
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More information2/21/2018. What are Opioids?
Opioid Crisis: South Carolina Responds Carolyn Bogdon, MSN, FNP-BC Coordinator for Emergency Department Medication Assisted Treatment Program Medical University of South Carolina Opioid Crisis: A Mounting
More informationOpiate Use Disorder and Opiate Overdose
Opiate Use Disorder and Opiate Overdose Irene Ortiz, MD Medical Director Molina Healthcare of New Mexico and South Carolina Clinical Professor University of New Mexico School of Medicine Objectives DSM-5
More informationOpioid Analgesics: Responsible Prescribing in the Midst of an Epidemic
Opioid Analgesics: Responsible Prescribing in the Midst of an Epidemic Lucas Buffaloe, MD Associate Professor of Clinical Family and Community Medicine University of Missouri Health Care Goals for today
More informationWasted AN INTRODUCTION TO SUBSTANCE ABUSE
Wasted AN INTRODUCTION TO SUBSTANCE ABUSE Dr. Brian L. Bethel Child and Family Therapist Independent Trainer and Consultant LPCC-S, LCDC III, RPT-S www.brianlbethel.com INTERPLAY COUNSELING & CONSULTING
More informationOpioid Use Issues: All the Players
Opioid Use Issues: All the Players Objectives After review, the participant will be able to: 1) Identify criteria for opioid use disorders Andrew J. McLean, MD, MPH Medical Director, ND Department of Human
More informationOpioids. Sergio Hernandez, MD
Opioids Sergio Hernandez, MD Required Slide Disclosures 1. SIGNIFICANT FINANCIAL INTERESTS NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT 2. GENERAL AND OBLIGATION INTERESTS All general
More informationAddressing Alaska s Opioid Epidemic From Understanding to Action
Addressing Alaska s Opioid Epidemic From Understanding to Action The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction
More informationPrescription Drugs MODULE 5 ALLIED TRADES ASSISTANCE PROGRAM. Preventative Education: Substance Use Disorder
Prescription Drugs MODULE 5 ALLIED TRADES ASSISTANCE PROGRAM Preventative Education: Substance Use Disorder Misuse of prescription pain relievers is, after marijuana use, the second most common form of
More informationSubstance Use Disorders
Substance Use Disorders Substance Use Disorder This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars monthly to address topics related to risk adjustment documentation and
More information5/29/2015. Responding to the Opioid Crisis. Responding to the Opioid Crisis. Objectives
Responding to the Opioid Crisis Responding to the Opioid Crisis David Cohen Ramsen Kasha Objectives Gain knowledge on Current opioid epidemic Historical perspective of opioids The impact of opioids on
More informationA look at Marijuana in 2014
A look at Marijuana in 2014 Paul Snyder MA., LADC Overview and Objectives Discuss the mental and physical effects of marijuana use Describe the criteria for Cannabis use disorder according to the DSM 5
More informationten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment
ten questions you might have about tapering (and room for your own) an informational booklet for opioid pain treatment This booklet was created to help you learn about tapering. You probably have lots
More informationMark Edlund, MD, PhD RTI International. Photo courtesy of The Herb Museum, Vancouver, BC
Opioid Use Disorders and Their Treatment Mark Edlund, MD, PhD RTI International Photo courtesy of The Herb Museum, Vancouver, BC Acknowledgements Funded by NIDA R01 DA022560-01 NIDA R01 DA034627 NIDA R01
More informationOtterbein Police Department. Opioid Addition Awareness
Otterbein Police Department Opioid Addition Awareness What are Opiates? Opioids are substances that act on opioid receptors to produce morphinelike effects. Medically they are primarily used for pain relief,
More informationPrescription Opioids
What are prescription opioids? Prescription Opioids Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made
More informationHOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain
Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid
More informationWhat is an opioid? What do opioids do? Why is there an opioid overdose crisis? What is fentanyl? What about illicit or bootleg fentanyls?
What is an opioid? What do opioids do? Why is there an opioid overdose crisis? What is fentanyl? What about illicit or bootleg fentanyls? What is an opioid? What do opioids do?: The term opioid can be
More informationPrescription Drug Misuse/Abuse in Seniors. April Rovero Founder/Executive Director
Prescription Drug Misuse/Abuse in Seniors April Rovero Founder/Executive Director Deaths per 100,000 Population 30 25 Overdose Demographics Drug Poisoning Death Rates by Age: United States (2010) 20 15
More informationH NDS-ONHealth. Prescription Drug Abuse. Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher.
H NDS-ONHealth Health Wave Newsletter, October 2013 Visit us on our website at www.healthwaveinc.com Drug overdose death rates in the United States have more than tripled since 1990 and have never been
More informationThe Unseen Consequences of Prescription Drug Abuse. Stephen Loyd, M.D.
The Unseen Consequences of Prescription Drug Abuse Stephen Loyd, M.D. Stephen Loyd, M.D. Receives no commercial support, in any form, from pharmaceutical companies or anyone else Medical Director for Substance
More informationKurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center
Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center Data from the National Vital Statistics System Mortality The age-adjusted rate of drug overdose deaths in the United States
More informationWhat is pregabalin? Pregabalin tablets. Pregabalin misuse. National Drug Treatment Centre Research. Administration
What is pregabalin? Pregabalin is a prescription drug used to manage a number of long-term conditions, including epilepsy, neuropathic pain and generalised anxiety disorder. Similar to benzodiazepines,
More informationModule II Opioids 101 Opiate Opioid
BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS Module II Opioids 101 Module II Goals of the Module This module reviews the following:! Opioid addiction and the brain!
More informationPrescription Opioid Addiction
CSAM-SCAM Fundamentals Prescription Opioid Addiction Presentation provided by Meldon Kahan, MD Family & Community Medicine University of Toronto Conflict of interest statement I received funds from Rickett
More informationImportant Information
Important Information Please work through the following pages with your patient or the patient s chart as necessary. Fax completed documents to 1 888 629-4722. Keep the original in your chart / file. Fee:
More informationHospital Based Opioid Management A case based, peer discussion
Hospital Based Opioid Management A case based, peer discussion A NNA MURLEY SQUIBB M.D. A S S O C I A T E P R O G R A M D I R E C T O R, S O I N F A M I L Y M E D I C I N E R E S I D E N C Y Disclosures
More informationMedication Assisted Treatment. MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment
Medication Assisted Treatment MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment Opioid Drugs Opium Morphine Heroin Codeine Oxycodone Roxycodone Oxycontin
More informationResponding to the Opioid Epidemic: Behavioral Health Specialists Role on the Interprofessional Team
Responding to the Opioid Epidemic: Behavioral Health Specialists Role on the Interprofessional Team Cheryl L Mejta, Ph.D. Nancy H Burley, Ed.D. Serena Wadhwa, Psy. D., LCPC, RYT, CADC Objectives Identify
More informationAppendix F Federation of State Medical Boards
Appendix F Federation of State Medical Boards Model Policy Guidelines for Opioid Addiction Treatment in the Medical Office SECTION I: PREAMBLE The (name of board) recognizes that the prevalence of addiction
More informationTop 10 narcotic pain pills
Top 10 narcotic pain pills Click to go to the item or just scroll down the page. Doctors Respond to FDA Panel Recommendations FDA Considers Banning Popular Prescription Pain Medications and. Top 10 Natural
More informationTapering Opioids Best Practices*
Tapering Opioids Best Practices* Chuck Hofmann, MD, MACP 5 th Annual EOCCO Office Staff and Provider Summit September 28, 2017 Disclosure No Conflicts of Interest to report Learning Objectives Understand
More informationOpioids and Heroin in Snohomish County. Marijuana and Opioid Prevention Training May 2018
Opioids and Heroin in Snohomish County Marijuana and Opioid Prevention Training May 2018 OPIOIDS 101 What are Opioids? Opioids 101 Opium Poppy Plant Opiates: A type of pain medication that is naturally
More informationTalking with your doctor
SUBOXONE (buprenorphine and naloxone) Sublingual Film (CIII) Talking with your doctor Opioid dependence can be treated. Talking with your healthcare team keeps them aware of your situation so they may
More informationOverview of Opiate Addiction
Overview of Opiate Addiction Conflict of interest 2 talks for Purdue about dangers of opioid addiction Bias support patients in both abstinence and methadone but seeing more stability on MMT Opioid Addiction
More informationSUBOXONE TREATMENT PROGRAM
SUBOXONE TREATMENT PROGRAM What is Suboxone? Suboxone is a medication used for the treatment of addiction to prescription pain medication, heroin addiction, methadone or other opioid dependence. The primary
More informationWhat Is Heroin? Examples of Opioids. What Science Says about Opioid Use Disorder and Its Treatment 6/27/2016
What Science Says about Opioid Use Disorder and Its Treatment Perilou Goddard, Ph.D. Department of Psychological Science Northern Kentucky University Examples of Opioids Agonists (activate opioid receptors)
More informationArticle #2 Prescription Drug Overdose CDC: Centers for Disease Control and Prevention. Understanding the Epidemic
Article #2 Prescription Drug Overdose CDC: Centers for Disease Control and Prevention Understanding the Epidemic When the Prescription Becomes the Problem In a period of nine months, a tiny Kentucky county
More informationWR Fentanyl Symposium. Opioids, Overdose, and Fentanyls
Opioids, Overdose, and Fentanyls Outline: What are opioids? Why are we experiencing and opioid crisis? Potency, purity, and product How do opioids cause overdose and overdose deaths? What is naloxone and
More informationSUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION
SUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION What is the most important information I should know about SUBOXONE Film? Keep SUBOXONE Film in a secure place
More informationSession 7: Opioids and Club Drugs 7-1
Session 7: Opioids and Club Drugs 7-1 The Importance of Total Abstinence Abstinence from all substances that affect the brain even alcohol greatly increases the chances of a successful recovery. Matrix
More information44th Annual CME Conference for Physician Assistants. Alexander Bautista, MD Assistant Professor Anesthesiology and Pain Medicine
44th Annual CME Conference for Physician Assistants Alexander Bautista, MD Assistant Professor Anesthesiology and Pain Medicine Fifth Vital Sign: 15 years later Opioid Epidemic Relevant Disclosure and
More informationKnock Out Opioid Abuse in New Jersey:
Knock Out Opioid Abuse in New Jersey: A Resource for Safer Prescribing GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN IMPROVING PRACTICE THROUGH RECOMMENDATIONS CDC s Guideline for Prescribing Opioids
More informationAttention Pain Sufferers. Advil-Aleve-Bayer-Celebrex-DemerolMotrin-Naproxen-Oxycontin- PercocetToradol-Tylenol-Ultram-Vicodin-Voltaren...
From the desk of Kris Belfry Enerkinetics Natural Health Care 2684 Los Palmas Crt. Mississauga, On L5N 2G7 (416) 627 3455 "If someone wishes for good health, one must first ask oneself if he is ready to
More information9/5/2011. Outline. 1. Past and Current Trends re: RX Abuse 2. Diversion Methods 3. Regulatory Reporting Requirements 4. Q/A
Prescription Drug Abuse Crises Outline 1. Past and Current Trends re: RX Abuse 2. Diversion Methods 3. Regulatory Reporting Requirements 4. Q/A 1 1970s 1980s 2 The 1990s OXYCODONE Oxycodone/APAP OxyContin
More informationPotentially serious side effects
page 2 of 7 page 3 of 7 page 4 of 7 Potential Health Consequences: First, consider the worst-case scenario death. This may sound far-fetched to a healthy young undergraduate, but people do actually die
More informationMedications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They?
Medications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They? Yngvild Olsen, MD, MPH Cecil County Board of Health Workgroup Meeting Elkton, MD October 8, 2013 Objectives
More informationWITHDRAWING FROM BUPRENORPHINE THERAPY
WITHDRAWING FROM BUPRENORPHINE THERAPY VARIOUS REASONS TO STOP BUPRENORPHINE pregnancy and lactation emergency surgery/elective surgery difficult to manage side effects of buprenorphine patients showing
More informationCharles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus
Pain & Opioid Epidemic 2018 Charles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus Opioids 3400 BC Mesopotamia, Joy plant 1843 morphine by syringe 1874
More informationImproving Health, Enriching Life. Pain Management. Altru HEALTH SYSTEM
Improving Health, Enriching Life altru.org Pain Management Altru HEALTH SYSTEM There are many different causes and kinds of pain. Pain can be caused by injury, illness, sickness, disease or surgery. Treating
More informationHEALTHCARE AND THE OPIOID EPIDEMIC DAN MUSE, MD SIGNATURE HEALTHCARE-BROCKTON HOSPITAL
HEALTHCARE AND THE OPIOID EPIDEMIC DAN MUSE, MD SIGNATURE HEALTHCARE-BROCKTON HOSPITAL DISCLAIMER HEALTHCARE AND THE OPIOID EPIDEMIC BROCKTON ER. MARCH 13,2017 25 year old male who just used heroin. Stated
More informationNeurobiology of Drug Abuse and Addiction PSYC 450
Neurobiology of Drug Abuse and Addiction PSYC 450 Healthy Control Drug Abuser Illicit drug use, lifetime and past year, in Canada 50 Canabis only Any drug Any of 5 drugs (without canabis) (CADUMS 2012)
More informationPeople inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, a practice called speedballing.
What is heroin? Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin
More informationNaloxone in Schools. Training for School Staff
Naloxone in Schools Training for School Staff Objectives Learn the signs and symptoms of opioid drug overdose Have the skills to administer naloxone Review the use of naloxone protocol in responding to
More informationLieutenant John Harless Mississippi Bureau of Narcotics
Lieutenant John Harless Mississippi Bureau of Narcotics Discuss current trends in drug abuse Increase awareness of the dangers of drug abuse Become familiar with the signs and symptoms of drug use 1 Controlled
More informationSCID-I Version 2.0 (for DSM-IV) Non-Alcohol Use Disorders
SCID-I Version 2.0 (for DSM-IV) Non-Alcohol Use Disorders *NON-ALCOHOL SUBSTANCE USE DISORDERS* (LIFETIME DEPENDENCE AND ABUSE) Now I am going to ask you about your use of drugs or medicines. SHOW DRUG
More informationOpioids drive continued increase in drug overdose deaths
CDC: Drug overdose deaths increase for 11th consecutive year Opioids drive continued increase in drug overdose deaths Atlanta, GA, USA (February 20, 2013) - Drug overdose deaths increased for the 11th
More informationSpotlight on Health Policy Beyond the Clinical: The Opioid Epidemic. October 25, 2017
Spotlight on Health Policy Beyond the Clinical: The Opioid Epidemic October 25, 2017 Disclosures and Disclaimer Neither the Institute for Health Policy and Leadership (IHPL) nor I have any relevant financial
More informationManaging Narcotics on Workers Comp Claims. Presented By: Craig S. Stern, PharmD, MBA President Pro Pharma Pharmaceutical Consultants, Inc.
Managing Narcotics on Workers Comp Claims Presented By: Craig S. Stern, PharmD, MBA President Pro Pharma Pharmaceutical Consultants, Inc. October 21, 2014 Outline Rationale Scope list drug list Recommended
More informationAnyone Can Become Addicted. Anyone.
Anyone Can Become Addicted. Anyone. PAStop.org Family Toolkit Seeking Drug Abuse Treatment: Know What to Ask Trying to identify the right treatment programs for a loved one can be a difficult process.
More informationNational Council on Patient Information and Education
National Council on Patient Information and Education You are not alone The type of pain that caused your doctor to prescribe a pain medicine for you can make you feel that you are different from everyone
More information(Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines)
Buprenorphine Initiation and Maintenance in Pregnancy (Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines) Assessment The diagnosis of OUD should be confirmed by DSM-5
More informationChapter 7. Screening and Assessment
Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions
More informationHOW TO PREPARE OXYCONTIN FOR INJECTION
HOW TO PREPARE OXYCONTIN FOR INJECTION How To Prepare Oxycontin For Injection Oxycontin epidemic article 15 clothing Oxycontin express report card 50 mg oxycontin identification card How much is 75 mg
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationThe Role of the PDMP: Foundational Knowledge and Best Practices
The Role of the PDMP: Foundational Knowledge and Best Practices Brent I. Fox, PharmD, PhD Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University DISCLOSURE I, Brent Fox, have
More informationAcute General Medical and Surgical Admission:
Acute General Medical and Surgical Admission: Managing Substance Use Disorders in Patients Who are Severely Ill Scott Grantham, MD Executive Director, Behavioral Health Saint Francis Health System By the
More informationOverview of Opioid Use Disorder
Overview of Opioid Use Disorder Doug Burgess, MD Medical Director of Outpatient Services, Truman Medical Centers Assistant Professor of Psychiatry, University of Missouri- Kansas City Objectives History
More informationOpioid Abuse in Iowa Rx to Heroin. Iowa Governor s Office of Drug Control Policy January 2016
1 Opioid Abuse in Iowa Rx to Heroin Iowa Governor s Office of Drug Control Policy January 2016 Why Is This Important? 2 3 National Rx Painkiller Trends CDC, 2013 4 National Rx-Heroin Trends NIH, 2015 5
More informationRecognizing Narcotic Abuse and Addiction and Helping Those With It
Recognizing Narcotic Abuse and Addiction and Helping Those With It Michael McNett, MD Medical Director for Chronic Pain Member, WI Med Society Opioid Subcommittee Ancient History 1995: OxyContin approved
More informationLONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE
LONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE DR. SHILPA ADARKAR ASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRY & DRUG DEADDICTION CENTRE OF EXCELLENCE SETH GSMC & KEMH LONG TERM OPTIONS FULL AGONIST PARTIAL
More informationOpioid Use in Youth. Amy Yule M.D. March 2,
Opioid Use in Youth Amy Yule M.D. March 2, 2018 An opioid is a substance that acts on opioid receptors Beta-endorphin Endogenous opioids Dynorphin Opiates Natural products of the poppy plant Morphine Heroin
More informationOPIOID OVERDOSE EPIDEMIC: What Healthcare Providers Need to Know
OPIOID OVERDOSE EPIDEMIC: What Healthcare Providers Need to Know WHAT S NEW UPDATE CUMBERLAND, MD Renata J. Henry, M.Ed. Director, Central East ATTC March 16, 2016 Behavioral Health is Essential to Health
More informationThe Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) دکتر راد گودرزی
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1 Expanded to include Gambling Disorder Cannabis Withdrawal and Caffeine Withdrawal are new disorders Caffeine Withdrawal
More informationPREVENTION. Carroll County Health Department. Bureau of Prevention, Wellness and Recovery
PREVENTION Carroll County Health Department Bureau of Prevention, Wellness and Recovery What is Prevention? Prevention is the promotion of constructive lifestyles and norms that discourage drug abuse.
More informationOPIOIDS FOR PERSISTENT PAIN: INFORMATION FOR PATIENTS
OPIOIDS FOR PERSISTENT PAIN: INFORMATION FOR PATIENTS This leaflet aims to help you understand your pain, so that you can work with your health care team to self-manage your symptoms and improve your quality
More informationMedication Assisted Treatment. Karen Drexler, MD National Mental Health Program Director-Substance Use Disorders Department of Veterans Affairs
Medication Assisted Treatment Karen Drexler, MD National Mental Health Program Director-Substance Use Disorders Department of Veterans Affairs Disclosures Employed by the Department of Veterans Affairs
More informationSUBSTANCE USE DISORDER IN ADOLESCENT POPULATION
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences SUBSTANCE USE DISORDER IN ADOLESCENT POPULATION ANNABELLE SIMPSON, MD UNIVERSITY OF WASHINGTON GENERAL DISCLOSURES
More informationThe Impact of Opioid Use and Abuse on Medical Community, Businesses, Social Organizations and Individiuals and Their Families
The Impact of Opioid Use and Abuse on Medical Community, Businesses, Social Organizations and Individiuals and Their Families THE MAGNITUDE OF THE OPIOID EPIDEMIC THE COSTS TO LOCAL, STATE AND NATIONAL
More informationOpioids: What You Should Know About Opioid Prescribing. Denis G. Patterson, DO Nevada State Medical Association October 19, 2016
Opioids: What You Should Know About Opioid Prescribing Denis G. Patterson, DO Nevada State Medical Association October 19, 2016 Contact Information Denis G. Patterson, DO Nevada Advanced Pain Specialists
More informationThe Opioid Epidemic and its Cost on Society and the Economy
The Opioid Epidemic and its Cost on Society and the Economy 6 out of 10 In 2014, more people died from drug overdoses than any other year on record with more than six out of ten deaths involving opioids.
More information3/16/2018. Responding to a crisis. Opioid Overdose Prevention
Opioid Overdose Prevention Responding to a crisis Agenda History of Opiates in the U.S. Understanding Opiates and New Developments Opioid Overdose: Physiology and Risk Factors Opioid Overdose: Signs and
More informationGrand Rapids Police Department
Heroin Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Columbia. Heroin can
More informationStrategies to Manage The Opioid Crisis
Strategies to Manage The Opioid Crisis Matt Feehery, LCDC Senior Vice President & CEO PaRC (Prevention & Recovery Center) Behavioral Health Services February 1, 2018 A Pill for Your Pain But my doctor
More informationResponding to the Opioid Addiction Epidemic
Responding to the Opioid Addiction Epidemic Andrew Kolodny, M.D. Chief Medical Officer, Phoenix House Foundation Inc. Executive Director, Physicians for Responsible Opioid Prescribing Senior Scientist,
More information``Considerations for using opioid drug therapy in workers compensation include patient safety, drug effectiveness and financial impacts
Opioids Effective Case Management Opioids RELEVANCE IN WORKERS COMP Opioids are a diverse group of drugs that represent the strongest pain medications available. They are frequently prescribed for pain
More informationThe Population is Abusing Drugs, but are Drugs Abusing Insurance?
Image licensed from Shutterstock The Population is Abusing Drugs, but are Drugs Abusing Insurance? 01/30/2018 Gina C. Guzman, MD, DBIM, FALU, FLMI, VP and Chief Medical Director Tim Morant, FSA, MAAA,
More informationMedication-Assisted Treatment. What Is It and Why Do We Use It?
Medication-Assisted Treatment What Is It and Why Do We Use It? What is addiction, really? o The four C s of addiction: Craving. Loss of Control of amount or frequency of use. Compulsion to use. Use despite
More informationOPIOIDS: THE GOOD, THE BAD, AND EVERYTHING IN-BETWEEN
OPIOIDS: THE GOOD, THE BAD, AND EVERYTHING IN-BETWEEN ANTOINETTE BROWN, RPH LAUREL RAMER, 2019 PHARMD CANDIDATE 2018 WYOMING CONFERENCE ON AGING LARAMIE, WY OCTOBER 3, 2018 OBJECTIVES 1. Understand the
More informationControlled Substance and Wellness Agreement
Controlled Substance and Wellness Agreement You and your provider have agreed on the use of controlled substance medications to treat your: We want to make sure you know how to manage your new prescription(s)
More informationProposed Revision to Med (i)
Proposed Revision to Med 501.02 (i) I. Purpose This rule has been adopted to enable the Board to best protect public health and safety while providing a framework for licensees to effectively treat and
More informationA National Challenge with a Community Solution. Officer Al Fear Eastern Iowa Heroin Initiative
A National Challenge with a Community Solution Officer Al Fear Eastern Iowa Heroin Initiative Midwest High Intensity Drug Trafficking Area Kevin W. Techau United States Attorney Northern District Of Iowa
More informationCAN YOU INJECT A G77 OPANA
CAN YOU INJECT A G77 OPANA Can You Inject A G77 Opana Opana taper after using for 3 weeks Can you cut opana er in half safely Opana sirloin tip roast recipe oven recipes easy recipes easy What is comparable
More informationNORTHWEST AIDS EDUCATION AND TRAINING CENTER. Opioid Use Disorders. Joseph Merrill M.D., M.P.H. University of Washington April 10, 2014
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Opioid Use Disorders Joseph Merrill M.D., M.P.H. University of Washington April 10, 2014 Opioid Use Disorders Importance of opioid use disorders Screening and
More informationHuntington Beach City School District DAC/DELAC February 7, 2013
Huntington Beach City School District DAC/DELAC February 7, 2013 Project funded by the County of Orange Health Care Agency Alcohol and Drug Education and Prevention Team 1 out of 5 teens have abused a
More information2/20/2019. Source: Source:
The misuse of and addiction to opioids including prescription pain relievers, heroin, and synthetic opioids such as fentanyl is a serious national crisis that affects public health as well as social and
More informationSuboxone Addiction & Treatment
Suboxone Addiction & Treatment The Risks of Addiction & When Help Is Needed Source : American Addiction Centers Content Overview What is Suboxone Addiction Treatment? Suboxone has been called a blockbuster
More informationOpioid Step Policy. Description. Section: Prescription Drugs Effective Date: April 1, 2018
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Opioid Step Policy Page: 1 of 6 Last Review Date: March 16, 2018 Opioid Step Policy Description
More information