Prescription Drug Abuse: Loosening the Knot

1. Prescription Drug Abuse: Loosening the Knot J. Patrick Slifka, LCSW & George Young, LCSW

2. Why We’re Here

3. Dealer out of Business? • http://www.youtube.com/watch?v=Cb93lPJB8yw

4. Which is More Dangerous? • http://www.youtube.com/watch?v=u_nCqak6mYQ

5. “Just The Facts” • All of these drugs are available – right now. • They do what they’re “advertised to do.” • If your individuals (particularly your adolescent ones) have not been already, they will soon be in a position to make a choice…to use or not to use. Their choice will carry both a benefit and a consequence.

6. “Just The Facts” • Drugs are not inherently evil, bad, or good – they’re simply chemicals. • The Relationship a person forms with a drug becomes the problem – and the problem gets progressively and significantly worse over time. • Remember that not all individuals have the same responses to the same drug or class of drugs. There are idiosyncratic reactions we have to assess and understand.

7. Why We’re Here? • Epidemic? Problem? • Attitude is the father of the Action • Ethical Obligation and Competent Practice

8. Jeopardy Time

9. Jeopardy Question #1 The Answer is: Patients leave a doctor’s office with this on 7 out of every 10 visits. What is a Prescription?

10. Jeopardy Question #2 The Answer is: Medicine Cabinets Where do a large number of teens who abuse prescription medications get their drugs?

11. Jeopardy Question #3 The Answer is: Dr. Gregory House and American High School Seniors identify this prescription drug as their favorite. What is Vicodin?

12. Trends and Statistics The Landscape

13. A View of the Landscape • http://www.youtube.com/watch?v=1sdFRJtzI0s

15. Rates of Rx drug sales, deaths and substance abuse tx admissions

21. 1 in 6 Teenagers

23. Most Commonly Abused Medications Among U.S. High School Seniors (2010 Annual Prevalence) Source: Monitoring the Future, University of Michigan, December 14, 2010

26. What is Driving the Prevalence? • Misperceptions about safety. • Increasing environmental availability • Varied motivations for their abuse.

27. Other Factors Driving Trend: Pill-Taking Society • Rx medications are all around us…and teens notice. • Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits. • Direct-to-consumer advertising on TV and in magazines. • Many people don’t know how to safely use these medications or ignore their doctor’s instructions.

28. Common Prescription Drugs of Abuse Signs, Symptoms and Biopsychosocial Consequences

29. Top 10 Most Dangerous Drugs in America (DAWN database of ER visits) • Xanax • Oxycontin • Vicodin • Methadone • Klonopin • Ativan • Morphine Drugs (opiates) • Seroquel (Antipsychotic) • Ambien • Valium

30. Most Commonly Abused Classes of Prescription Drugs • Opioid Pain Relievers (Opiates, Narcotics) • CNS Stimulants (primarily those used in the tx of ADHD) • CNS Depressants (Sedatives, Hypnotics, Anxiolytics)

31. Key Assessment Point: Effects of Drugs Depend on… • Route of administration • Amount taken at one time • User’s past drug experience • Circumstances under which the drug is taken (the place, the user’s psychological and emotional stability, the presence of other people, simultaneous use of alcohol and other drugs, etc.)

32. Commonly Abused Rx Drugs

33. Opioid Pain Relievers (Opiates/Narcotics)

34. What are Opiates? • Opiates are a group of drugs that are used for treating pain. They are derived from opium which comes from the poppy plant. • Opiates go by a variety of names including opiates, opioids, and narcotics. The term opiates is sometimes used for close relatives of opium such as codeine, morphine and heroin, while the term opioids is used for the entire class of drugs including synthetic opiates such as Oxycontin. But the most commonly used term is opiates.

35. Dried Opium Poppy

36. Commonly Used & Abused Opiates • Opium • Codeine …anybody you’re working with taking any of these? • Morphine • Tramadol (Ultram) • Methadone • Buprenorphine (Subutex) • Propoxyphene (Darvocet) • Pethidine (Demerol) • Hydrocodone (Lortab/Vicodin) • Oxycodone (Percocet, Oxycontin) • Hydromorphone (Dilaudid) • Oxymorphone (Opana) • Fentanyl • Heroin (diacetylmorphine)

37. Most Rx’d Opiate in America

38. Oxycontin

39. Opiates • Opiates are highly effective in controlling moderate to severe pain, but they also have a downside. Opiates are highly addictive…and once a person starts abusing them he/she generally becomes dependent (addicted) to them.

40. Feelings of Euphoria Suppression of Pain Depressed Respiratory Rate Lowered Heart Rate and Blood Pressure Lethargy/Drowsiness Clouded Mental Functioning Nausea/Vomiting Lowered Body Temperature Muscle and Bone Pain Physical/Psychological Dependence Severe Withdrawal Symptoms Mood Swings Severe Constipation Unconsciousness Coma Death by Overdose Opiate Effects

41. Opiates: Long Term Effects • Cause significant changes to the nerochemical, molecular and cellular levels. • Changes brain structure and functioning that lasts well beyond the substance use. • These changes are part of what can trigger drug cravings years after last use.

43. How Do Opiates Work? • Opiates elicit their powerful effects by activating opiate receptors that are widely distributed throughout the brain and body. Once an opiate reaches the brain, it quickly activates the opiate receptors that are found in many brain regions and produces an effect that correlates with the area of the brain involved.

44. How Do Opiates Work? • Two important effects produced by opiates, such as morphine, are pleasure (or reward) and pain relief. The brain itself also produces substances known as endorphins that activate the opiate receptors. Research indicates that endorphins are involved in many things, including respiration, nausea, vomiting, pain modulation, and hormonal regulation.

45. Opiate Agonists • Opiate agonists are drugs that stimulate the opioid receptors in the brain, leading to the high associated with opiate drugs. They include Heroin, Vicodin, Morphine, Codeine and Methadone. • They mimic the effects of naturally-occurring endorphins in the body, and produce an opiate effect by interacting with the opioid receptor sites.

46. Opiate Antagonists • Opiate antagonists block the brain’s opioid receptors, making it impossible for opiate drugs to stimulate them. For example, drugs like Naloxone and Naltrexone make it so that, if the user were to take a drug like heroin afterwards, there would be no high. • These medications are often used to combat the overdose effects of an opiate or to help break an addiction.

47. Partial Opiate Agonists • Partial opiate agonists are drugs that have a “ceiling effect.” In other words, they can only stimulate the opioid receptors to a certain extent. Buprenorphine, the main ingredient in Suboxone, is one of these. No matter how much Suboxone you take, its effects are limited.

48. Sedatives, Hypnotics, and Anxiolytics

49. Sedatives, Hypnotics and Anxiolytics • Drugs that reversibly depress the activity of the central nervous system. Barbiturates, Benzodiazepines, and other sedative-hypnotics have diverse chemical and pharmacological properties that share the ability to depress the activity of all excitable tissue, especially in the arousal center of the brainstem. • Barbiturates(Sedatives): Amytal, Nembutal, Seconal and Phenobarbital. • Benzodiazepines(Anti-Anxiety): Ativan, Halcion, Librium, Valium, Xanax, and Rohypnol. • Other Sedative-Hypnotics (Sleep Inducers): Lunesta, Sonata, Ambien.

50. Barbiturates In therapeutic doses, barbiturates are effective and are typically used for seizure disorders and anesthesia. Using them to “get high” is extremely dangerous because there is a relatively small difference between the desired dose and an overdose. A small miscalculation, which is easy to make, can lead to coma, respiratory distress (breathing slows or stops) and death. Withdrawal from barbiturates is similar to, and sometimes more severe than, alcohol withdrawal. Seizures are possible and can also lead to death.