ADDICTION OPIOID ADDICTION

Transcription

1 ADDICTION OPIOID ADDICTION

2 DRUG ADDICTION Take Home Points 1 Drug addic=on is impossible to avoid in your prac=ce 2 Huge burden on economy, families, society 3 Drug addic=on is Treatable drug addicts deserve treatment and compassion 4 Addic=on medicine is the most rewarding field of medicine 5 How not to contribute to the problem

3 Addicts in the Workforce In 2009, current drug users over 18 were 67% were employed 48% employed full-=me 19% employed part-=me 13% unemployed 21% not in the labor force Source: Office of Na=onal Drug Control Policy

4 KAISER FAMILY FOUNDATION HEALTH TRACKING POLL (Nov ) Of people responding to the survey: 6% had abused painkillers 25% had friend/family abusing painkillers 45% knew people who abused painkillers 39% knew someone who became addicted 16% knew people who died from an overdose 9% lost a rela=ve or good friend to overdose. 56% of Americans touched by prescrip=on painkiller addic=on.

5 Economic Burden of Addic=on In 2007 $120 Billion in lost produc=vity Labor par=cipa=on, drug abuse treatment, incarcera=on, early death $11 Billion in medical costs $61 Billion in criminal jus=ce costs $193 Billion Source: Office of Na=onal Drug Control Policy

6 Economic Burden of Addic=on The total es=mated cost of diabetes in 2007: $116 billion in excess medical expenditures $58 billion in reduced na=onal produc=vity. $174 billion Total Economic cost of addicqon in 2007 was $193 billion

7 Cost of Substance Abuse Cost in Billions of US Dollars (2013)

8 What is AddicQon? Not the same thing as Physical Dependence Most addicts don t know the difference Many addic=ons have minimal physical dependency cocaine methamphetamine gambling

9 What is AddicQon? Not simply a mafer of Bad Choices

10 WHO PUT A GUN TO YOUR HEAD TO USE DRUGS?

11 WHO PUT A GUN TO YOUR HEAD TO EAT THAT JELLY DONUT?

12 What is AddicQon? Addic=ons are NOT Ra=onal

13 What is AddicQon? Addic=on is a Brain Disorder

14 What is AddicQon? Addic=on is a Brain Disorder

15 What is AddicQon? Addic=on is a Brain Disorder RegulaQng Brain temperature sleep/wake hunger/sa=ety pulse/respira=on rate electrolytes etc

16 What is AddicQon? Addic=on is a Brain Disorder RegulaQng Brain existen=al threats opioid withdrawal = regula=ng brain gone amok no temporal dimension

17 HOW TO DEAL WITH ADDICTS Treat addic=on as a disease Treat addicts as pa=ents, not as criminals Do not judge, do not abandon

18 HOW TO DEAL WITH ADDICTS

19 Practice Guidelines Respect Your Pa=ent Respect Opioids Respect Your Profession

20 Practice Guidelines Respect Your Pa=ent Compassion Most addicts have suffered terrible misfortunes They deserve & need our care, not our disdain See them as people They have parents, children, and other loved ones

21 Practice Guidelines Respect Opioids Pain kills no one Painkillers kill more than 3 people a day in Indiana Comparison with other drugs taken off market Baycol: 31 deaths Propulsid: 70 deaths Rezulin: 63 deaths

22 Practice Guidelines Respect Opioids

23 Practice Guidelines Respect Opioids

24 Practice Guidelines Respect Opioids Even short-term use for acute pain RelaQonship Between Early Opioid Prescribing for Acute OccupaQonal Low Back Pain and Disability DuraQon, Medical Costs, Subsequent Surgery and Late Opioid Use Webster, Barbara S., Verma, Santosh K., Gatchel, Robert J. Spine 2007, 32(19), pp claimants from a large WC database with new-onset, disabling LBP that occurred between January 1, 2002 and December 31, Separated into quin=les based on opioid exposure over the first 15 days (0, 1 140, , , 450+). [Note: highest group of 450 MEA = Norco 7.5 qid for 15 days]

25 Practice Guidelines Respect Opioids Webster et al. Spine 2007, 32(19) 2127

26 Practice Guidelines Respect Opioids Webster et al. Spine 2007, 32(19) 2127

27 Practice Guidelines Respect Opioids Webster et al. Spine 2007, 32(19) 2127

28 Practice Guidelines Respect Opioids Webster et al. Spine 2007, 32(19) 2127

29 Practice Guidelines Respect Opioids Addic=on poten=al Even short courses of opioids can lead to addic=on

30 Practice Guidelines Respect Your Profession Primum Non Nocere First, Do No Harm

31 Practice Guidelines Respect Your Profession If you idenqfy potenqal addicqon Treat the pa=ent with dignity Do not fire them or abandon them to their own devices (due to your own discomfort) Generally safe to taper and discon=nue pain medica=ons while making a referral Treat their other medical condi=ons as with any other pa=ent In other words, just be a doctor!

32 Practice Guidelines Respect Your Profession Learn more about addic=on medicine Least understood area of medicine Most rewarding field of medicine

33 Treatments for Opioid AddicQons 4 strategies: Non-medica=on assisted therapy Methadone Clinics Buprenorphine maintenance Naltrexone vivitrol injec=ons

34 Treatments for Opioid AddicQons Non-MedicaQon Assisted Therapy Detox - NOT sufficient! Rehab Counseling 12-step programs

35 Methadone Clinics Word on the street: It s worse than heroin It gets into your bones It s just switching one addic=on for another It s too expensive Truth is: Decreases fatal overdoses Reduces HIV/Hepa==s Fewer arrests Many are able to hold down a job COST ~$300/month

36 Methadone for Pain Benefits: Cheap, long-ac=ng Befer for neuropathic pain? Why It s Dangerous: 5% of the pain market; 40% of fatal overdoses Suppresses breathing longer than pain Unpredictable pharmacodynamics and variable half-life Drug-drug interac=ons QTc prolonga=on No safe opioid conversion What you need to know: No special license needed to con=nue methadone for inpa=ents Be careful with drug interac=ons

37 BUPRENORPHINE Par=al agonist can precipitate withdrawal ceiling agonist effect (INSPECT claims 300%MED) less respiratory depression special X-license needed to prescribe for addic=on works for pain but off-label

38 Suboxone = Buprenorphine + Naloxone Maintenance vs. Detox Other prepara=ons: generic buprenorphine/naloxone zubsolv bunavail Buprenorphine only: buprenex (IM/IV) subutex (buprenorphine HCl)

39 What To Do For Hospitalized PaQents on Buprenorphine Call the buprenorphine provider! Run an INSPECT report and get a urine drug test If pa=ents on suboxone need short-term pain relief, buprenorphine works for pain 1. X-licenses not necessary for inpa=ents not necessary to stop suboxone 2. possible strategies: increase suboxone : change to straight buprenorphine : add hydromorphone

40 hfps://

41 Title 21 CFR - Part Sec=on (c) This sec=on is not intended to impose any limita=ons on a physician or authorized hospital staff to administer or dispense narco=c drugs in a hospital to maintain or detoxify a person as an incidental adjunct to medical or surgical treatment of condi=ons other than addic=on, or to administer or dispense narco=c drugs to persons with intractable pain in which no relief or cure is possible or none has been found azer reasonable efforts. Administer/Dispense Prescribing

42 VIVITROL (NALTREXONE) Opioid antagonist Indicated for alcohol dependency as well as opioid dependency Once a month shot No special DEA license needed