Part 1

1. Part 1

2. Opening remarks Fire exits Cell phones Paper work for Credit and for Narcan Website availability of presentations Intro of dignitaries if present Order of the day CASA Report and WHO report 40milllion addicted 80 million risky users at a cost of more than 600 Billion per year Medication Assisted Treatment Care Reform and Parity Community Mobilization Q&A Lunch Current Trends in Substance Use Pain Management Issues in Treatment Settings Veteran’s Issues and Substance Use Q&A # PM Narcan Training for those interested

3. CASA Columbia Report • 40 million Americans addicted • About 29 million being spent to treat • 80 million Americans risky users • No direct funding for this group (except for SBIRT)

4. From Feb 2012 SAMHSA report • Admissions aged 15 to 17 most frequently reported marijuana (71.9percent) or alcohol (17.7 percent) as their primary substance of abuse • About 14.3 percent of older adolescent admissions reported first using their primary substance of abuse at age 11 or younger, and over half (56.3 percent) reported first using their primary substance between the ages of 12 and 14 • Almost one third (32.2 percent) of admissions aged 15 to 17 had been admitted to treatment at least once prior to their current treatment episode • Among older adolescent admissions, the most commonly reported principal source of referral to treatment was the criminal justice system (51.2 percent)

5. Past Month Illicit Drug Use among Adults Aged 50 to 59: 2002-2011 8 50 to 59 50 to 54 55 to 59 7.2 7.0 6.7 7 6.3 6.0 6.3 5.7 Percent Using in Past Month 6 5.7 5.4 5.2 6.0 5.0 5.0 4.8 5 4.4+4.4+ 4.6+ 4.1 3.9+ 3.8+ 4 3.4+ 3.4+ 4.3+ 4.1 3.1+ 2.6+ 2.7+ 2.4+ 3 1.9+ 2.0+ 2 1 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

6. PRESCRIPTION PAIN KILLERS The Centers for Disease Control and Prevention has classified the misuse of these powerful painkillers as an epidemic, with 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.

7. Suffolk County Preventing Misuse of Prescription Opioid Drugs 2012 . 2

8. Nassau County “Statistics show that 70% of children who abuse prescription drugs get them from family or friends.” County Executive Mangano • “Admissions for alcohol abuse have always represented the largest number of admissions, but have been steadily decreasing. • The number of admissions for heroin and prescription drugs as a primary substance of abuse has increased over the last several years. • Admissions for opioids alone have increased by 60% between 2007 and 2010. • Admissions for prescription drugs including Xanax and OxyContin, and other opioids such as Vicodin and Percocet, have all increased across all the different services in Nassau County. • There were 747 admissions in 2007, that number increased to 1,356 in 2010, an increase of 82%. • Admissions for OxyContin alone increased 160% during the same time period. • Admissions to Crisis Services, which represent the highest level of care in the county, for OxyContin increased 250% from 80 admissions in 2007 to 281 in 2010. • Of particular concern is that the number of admissions of young adults in the 19-26 age groups has significantly increased. • These admissions place even more importance on prevention efforts aimed towards the younger population still in middle and high school and to engage parents and communities in prevention activities.”

9. Suffolk County Data • In Suffolk County, deaths involving opiates have risen since 2004. • The number of deaths in which non-heroin opiates played a part in the cause of death increased by 70% between 2004 and 2011. • The incidence of one opiate in particular, oxycodone, more than tripled between 2004 and 2011. • Oxycodone appears in nearly one-third of all reports and fentanyl in nearly one-quarter of the reports.

10. SILK ROAD As of 2012, annual sales are estimated to be 22 million US dollars Buyers and sellers conduct all transactions with Bitcoin, a crypto-currency that can provide strong anonymity.[11]

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12. DrugRecipesIndex Growing Magic Mushrooms Growing Marijuana How to Pass a Drug Test---Detection Times---Methods of Drug Testing---Drug testing Standards and Accuracy---Note on Commercial Products---Tests to Detect Counter Measures---Producing Clean Urine---Drug Screens---Doping Samples---Substitution---Stealing Urine---If You Fail the Test---Who does Drug Testing---Ethics of Drug Testing

14. MEDICATION ASSISTED TREATMENT (MAT) MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.

16. Potential Benefits Improve survival Increase retention in treatment Decrease illicit opiate use Decrease hepatitis and HIV seroconversion Decrease criminal activities Increase employment Improve birth outcomes with perinatal addicts

17. Medications for Alcohol Dependence Naltrexone (ReVia®,Vivitrol®,Depade®) Disulfiram (Antabuse®) Acamprosate Calcium (Campral® Medications for Opioid Dependence Methadone Buprenorphine (Suboxone® Subutex®) Naltrexone

18. Other Agents • BACLOFEN • BUPROPION • VARENICLINE • ONDANSETRON (Zofran) • NALMEFENE

19. Varenicline and Alcohol • Alcohol dependence and tobacco dependence are frequently co-morbid conditions. It has been reported in rodent studies that varenicline reduced alcohol intake. • Ericson (J Pharmacol Exp Ther. 2009; 329(1):225-30) • Mckee (Biol Psychiatry. 2009; 66(2):185-90)

20. ONDANSETRON(Zofran) Used to treat nausea in chemotherapy patients.

21. NALMEFENE • Opioid antagonist similar to naltrexone • Recent research demonstrated that it may have advantages to • naltrexone because there is: • no risk of liver toxicity, • higher biologic activity than naltrexone • longer acting. • Dr. Barbara Mason's research showed that patients treated • with nalmefene during a 12-week trial were 2.4 times less • likely to relapse from alcohol than those treated with a placebo

22. Ibogaine Ibogaine and its derivatives show promise at blocking withdrawal symptoms and drug cravings long enough to provide an opportunity for extending behavioral treatment, thereby improving treatment outcomes. Can LSD cure alcoholism? Trials show 59 per cent of problem drinkers improve after a single dose.

23. OLD TREATMENTS Kudzu root, flower, and leaf are used to make medicine. It has been used in Chinese medicine since at least 200 BC. As early as 600 AD, it was used to treat alcoholism Sensory imagery Acupuncture Mindfulness training

24. New Treatments • Studies focusing on • gamma-aminobutyric acid receptors • voltage-gated ion channels • transcranial magnetic stimulation • dopamine D3 receptor (D3R) • α-type peroxisome proliferator-activated receptors (PPARα) (clofibrate)

25. Randomized controlled trial of a novel cannabis use intervention delivered by telephone Aims To evaluate the efficacy of a telephone-based intervention consisting of four sessions of motivational interviewing (MI) and cognitive behavioral therapy (CBT) designed to assist individuals to reduce their cannabis use and related problems. Conclusions A brief course of motivational interviewing plus cognitive behavioral therapy delivered by telephone can help to reduce cannabis dependence and promote abstinence in the short term.

26. Legal Action Center