OPIOID ABUSE 5/4/2018 WHAT IS AN OPIOID? OBJECTIVES:

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1 OPIOID ABUSE A WORLDWIDE CRISIS OBJECTIVES: What is an Opioid? How do they work? Discuss other common uses Ways Opioids are Administered What is Addiction? Discuss the statistics Treatment options Consequences of using Opioids WHAT IS AN OPIOID? An opium-like compound that binds to one or more of the three opioid receptors of the body. Opium s alkaloids: Naturally Occurring- Morphine, Codeine Semi-synthetics Oxycodone, hydrocodone, oxymorphone Heroin Synthetics Methadone, fentanyl, sufentanyl 1

2 HOW DO THEY WORK They work on the Central Nervous System to reduce pain perception and they also decrease wakefulness OPIOIDS WORK BY.. Attach to opioid receptors throughout the brain, spinal chord, & GI tract Most effects of opioid use is related to the effect of blocking the MU sites OPIOIDS & RECEPTOR ACTIVITY AGONIST Antagonist Partial agonist Totally blocks the receptor site By binding to the site Reverses or Inhibits the effects of the agonist Does this by blocking access to the site Submaximal response Even at high doses Mixed Divergent activities at different receptor sites 2

3 OTHER MEDICAL USES: Suppression of diarrhea Replacement therapy for opioid use disorder (antagonists) Reversing opioid overdose (antagonist) Suppressing cough and Opioid-induced constipation. OTHER NON-PAIN RELIEF USES FOR OPIOID COMPOUNDS NARCAN antagonist TUSSICAPS dextromethorphan METHADONE agonist LOMOTIL slows gastric motility Relistor antagonist-block receptor sites in GI tract to prevent constipation B&O suppositories belladonna & opium DID YOU KNOW? We also have endogenous opioids: Endorphins Dynorphins Enkephalins Nociceptin 3

4 LOOKING AT THE HISTORY OF OPIUM, HELPS US TO KNOW.. THE HISTORY OF OPIOIDS This Photo by Unknown Author is licensed under CC BY-SA OPIUM WHERE OPIOIDS COME FROM A reddish-brown heavyscented addictive drug prepared from the juice(latex) of the opium poppy, used as a narcotic and in medicine as an analgesic. This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA 4

5 LATEX OF THE OPIUM POPPY Comes from the immature pods Obtained by cutting into the pod, allowing the latex to dry. The dried latex dries into poppy tears can be used to make natural opiates, such as opium and morphine Or can be chemically altered to make heroin. This Photo by Unknown Author is licensed under CC BY-SA HISTORY OF OPIUM USE Earliest reference to opium growth and use is in 3,400 B.C. Cultivated in lower Mesopotamia (Southwest Asia). Sumerians referred to it as Hul Gil, the "joy plant." Sumerians passed it on to the Assyrians, who passed it on to the Egyptians. Countries began to grow/process opium to expand its availability/decrease cost. Cultivation spread along the Silk Road, from the Mediterranean through Asia and finally to China where it was the catalyst for the Opium Wars of the mid-1800s. OPIUM WARS TWO WARS DISPUTING TRADE PRACTICES BETWEEN BRITAIN & CHINA British wanted more Chinese products, using opium (from their British controlled, East-Indian trading company), smuggled Indian opium into China This resulted in an increasing addiction problem in China. When Chinese migrants came to America to work on the railroads, they brought their use of opium to the U.S. Opium dens became prevalent throughout China, parts of Southeast Asia, Europe, and the U.S. Use in the U.S. spread from West to East 5

6 MEDICINAL PLANT Ancient Greeks and Romans knew of the medicinal qualities Pain relief Promote sleep Aid the bowels Protect from poisoning Providing pleasurable effects This Photo by Unknown Author is licensed under CC BY-NC-ND RECAP OPIOIDS ARE: Substances that act on opioid receptors producing a morphine-like effects are agonists. Used for pain relief, including anesthesia. Extremely potent opioids such as carfentanil are only approved for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal. This Photo by Unknown Author is licensed under CC BY-NC-ND OPIOIDS Morphine main source of pain relief in many hospitals Levorphanol very powerful opioid similar to morphine Severe pain, rarely ever prescribed Oxycodone oral pain reliever (aka oxycontin/roxicodone) Buprenorphine strong opioid Chronic pain, help with Hydrocodone derivative of codeine oral less pain addiction Tramadol opioid analgesic moderate pain/similar to Heroin rapid acting/highly addictive, man-made derivative of morphine morphine Methadone moderate to severe pain similar to morphine, Fentanyl heroin like effects Severe pain, when others do not help to detox morphine or heroin work. Highly addictive Hydromorphone cm hospital, morphine derivative, chronic Meperidine fast-acting, highly addictive, opioid derivative, pain managing mod. severe pain. Tapentadol prescription pill, mod-severe pain Anileridine oral/injectable mod-severe 6

7 WAYS TO CATEGORIZE WAYS TO ADMINISTER Liquid Sub-buccal Tablets Suppositories Injectable IV/IM Enemas Inhaled Ocular Transdermal Epidural/intrathecal Pain pumps VARIOUS FORMS Immediate release Sustained release Controlled release Combination i.e. combined with acetaminophen/aspirin WHAT IS ADDICTION? ACCORDING TO DICTIONARY.COM IT IS THE STATE OF BEING ENSLAVED TO A HABIT OR PRACTICE OR TO SOMETHING THAT IS PSYCHOLOGICALLY OR PHYSICALLY HABIT- FORMING, AS NARCOTICS, TO SUCH AN EXTENT THAT ITS CESSATION CAUSES SEVERE TRAUMA. This Photo by Unknown Author is licensed under CC BY-SA STATISTICS IT IS AN EPIDEMIC This Photo by Unknown Author is licensed under CC BY-NC-ND 7

8 NIDA NATIONAL INSTITUTE ON DRUG ABUSE the abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. The amount of people who abuse opioids worldwide numbers in the millions between 26.4 million and 36 million, approximately. DRUG OVERDOSES ACCOUNT FOR THE LARGEST CAUSE OF DEATH FOR ADULTS In ,000 adults died as the result of car crashes. About the same amount died from gun violence HOWEVER, around 47,000 people overdosed (OD ed) during that same period. This Photo by Unknown Author is licensed under CC BY-NC-ND 8

9 INSTITUTE OF MEDICINE (IOM) REPORT Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, 2011 More than 2 million Americans are abusing prescription opioids Nearly half a million more are abusing heroin Research shows prescription opioid use is associated with heroin abuse RISE IN PRESCRIPTIONS Opioid prescriptions Rise 219,000, ,000, year opioid prescriptions EMERGENCY ROOM VISITS RELATED TO OPIOIDS 350,000 ER VISIT INCREASE IN 4-YEAR SPAN 300, , , , ,000 50, , ,000 Addiction is rare in patients treated with narcotics

10 ADMISSIONS FOR TREATMENT Increase in Admissions for Addiction treatment in a 10 year Span Axis Title 2007, 5.0% 1997, 1.0% Admitted for Abuse of Opioids #REF! MISSOURI Health and Senior Services Working with sister agencies, Local Health departments Hospitals Law Enforcement And Others We know that every person saved from an overdose or connected with rehabilitation resources is a mother, father, sibling or child to someone else.(m0 DHSS, 2018) MISSOURI STATISTICS 10

11 SOMETIMES IT IS NOT JUST THE USER WHO IS AFFECTED Missouri among 5 states selected to participate in project addressing maternal opioid use (2/21/2018) This Photo by Unknown Author is licensed under CC BY-SA MISSOURI S OPIOID PRESCRIPTION DISTRIBUTION SEPARATING DRUG SEEKING BEHAVIORS FROM OTHER MEDICAL NEEDS We would see quite a few people with drugseeking behavior coming in with vague symptoms, stories that didn t pan out and basically, they wanted narcotics. Unfortunately, sometimes drug addicts can also have health issues. So, you can t just have a blanket policy of No, we don t dispense when we suspect drug abuse. Drug addicts have bodies just like we do, and they do have pain issues. T. Emery,

12 THE DRUG CRISIS IN MISSOURI In the Show-Me State in the past decade, opioid abuse has increased by 137 percent. Take a look at the following statistics: According to the Henry J. Kaiser Family Foundation, of the approximately 38,600 overdose deaths that occurred in the United States in 2015 due to opioids, nearly 800 occurred in Missouri. According to a study released by the Centers for Disease Control in July 2017, rural areas in Missouri have been hit the hardest by the opioid epidemic particularly northern Missouri, the southeast corner of the state, and many counties surrounding Springfield (source). Why are rural areas so heavily affected? Experts believe this may be due to rural areas having older populations, more physically demanding jobs, and fewer options for pain relief (such as physical therapy and surgery). According to the Missouri State Highway Patrol s Division of Drug and Crime Control, in 2011 and 2012, they seized between 100 and 200 grams of heroin. By 2016, they seized over 41,000 grams. Recently, the largest seizure of fentanyl occurred in Missouri. During a routine traffic stop, police searched a vehicle and found 4.8 pounds of pure fentanyl. For a reference, coming in contact with as little as 2 milligrams of fentanyl can be deadly (source). SPRINGFIELD, MISSOURI The Police Department responded to 94 overdose calls between January and June Out of those 94, seven died. We had to deal with meth for so long, and now we have to deal with something potentially more dangerous to citizens, It is just tough to know that it has gotten worse. Not that we re not making a difference, but we re fighting meth and then the next day we re dealing with people that are overdosing in their homes from heroin. Lt. Eric Reece, Springfield PD. STREET NAMES INCLUDE: Apache, China girl, China white, Dance fever, Dillies, Friend, Goodfella, Hillbilly Heroin, Jackpot, Juice, Murder 8, Oxy 80, Oxycat, Percs, Perks, Tango and Cash, and TNT. 12

13 TREATMENT OPTIONS Detox rid the body of the toxic substances usually accompanied by harsh withdrawal symptoms Best as an inpatient Treatment programs Professional help Away from triggers Support from others going through the same experience Learning to live without. Using Behavior Modification Counseling for continued assistance and coping mechanisms Treat body, mind, and spirit This Photo by Unknown Author is licensed under CC BY WHAT ARE THE CONSEQUENCES OF TAKING OPIOIDS? This Photo by Unknown Author is licensed under CC BY EFFECTS OF OPIATE USE Weakened immune system. Gastric problems - from the troublesome (e.g., constipation) to severe (e.g., intestinal ileus, bowel perforation). A plethora of medical issues secondary to intravenous administration (e.g., localized abscesses, embolic events, systemic infection, contraction of bloodborne illnesses). Significant respiratory depression; cumulative hypoxic end-organ injury. This Photo by Unknown Author is licensed under CC BY-SA 13

14 WHAT HAPPENS YOU A PERSON On OPIOIDS? 14

15 LOCATION OF THE TRICUSPID AND MITRAL VALVES This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-SA VIEW OF THE HEART WITH ECHOCARDIOGRAM SHOWING VEGETATIVE BUDS INFECTIVE ENDOCARDITIS LINKED TO IV DRUG USE The number of patients admitted to US hospitals for infective endocarditis (IE) related to IV drug use has more than doubled over the last several years, racking up an average of $72,000 in expenses each time. Data extracted from the National Inpatient Sample estimated nearly 250,000 admissions for IE occurred from 08 to 14. Hospitalization r/t IE The portion of which is related to IV drug use, 50,000 39,805 increased from % 40,000 33,073 30,000 By 2014, 27%of IE cases under 30, were r/t drug use, 20,000 Were in large part Caucasian women, insured by Medicaid. 10, Hospitalization r/t IE 15

16 WHERE ARE WE HEADED? Admissions have doubled There is higher post-op morbidity And large resource utilization Costs are nearly doubled from regular heart surgery The upward trajectory of this crisis is going to continue to Get worse, unless plans are set in motion. VEGETATIVE BUDS 16

17 SUMMARIZING Opioid abuse is prevalent Not everyone using prescription meds become addicted but statistics indicate there is a connection Addiction happens at the cellular level due to many variables. Overdose occurs because the user needs higher and higher amounts to achieve the same level of euphoria AND drug concentration levels are highly variable. When persons become infected due to IV drug abuse, they will require long-term antibiotic administration and are likely to be hospitalized the entire time to keep them from using their IV access for injecting themselves. 17

18 REFERENCE Addiction, Dictionary.com, Cannabis, Coca, & Poppy: Nature s Addictive Plants, Drug Crisis in Missouri, :// Flanagan, H & Sumpter, H, Jan 15, 2018,The opioid epidemic in Greene County: How has our community been impacted? The STANDARD, Missouri State University, List of all Opioids in the United States, RehabCenter.net Missouri Department of Health & Senior Services (DHSS), Missouri Opioids Information, n.d., Missouri Opioids Information, n.d. DHSS Missouri Department of Health & Senior Services, National Institute on Drug Abuse, Advancing Addiction Science, Drugs, Brains, and Behavior: The Science of Addiction, Addiction and Health, What are the medial consequences of drug addiction?, Researchers: Infective endocarditis linked to IV drug use a growing healthcare crisis, n.d. What is infective endocarditis? Dove Med, n.d., 18