Heather Davidson and Jim Hall History of Opiates in the U.S. It - PowerPoint PPT Presentation

Presented by: Heather Davidson and Jim Hall

History of Opiates in the U.S. • It was from opium that morphine was derived as a pain killer in 1810. • Due to the euphoria that it produced it was named after the Greek god of dreams, Morpheus, by a German physician. • Morphine was heavily used to treat pain in soldiers during the Civil War, leaving many addicted to morphine. • In 1874, a new drug, Heroin was created in Germany and sold in the United States as a “safe, non - addictive” substitute for morphine.

History of Opiates in the U.S.

History of Opiates in the U.S. • Laudanum was a mixture of opium in an alcohol base and used as we would use aspirin today. • Heroin, morphine and other opiates were sold legally in the U.S. until 1920 with the passing of the Dangerous Drug Act. • In 1925, there were an estimated 200,000 heroin addicts in the U.S.

Cultural Acceptance of Rx Drugs

• The rate for drug overdose deaths has increased approximately 140% since 2000, driven largely by opioid overdose deaths. • After increasing since the 1990s, deaths involving the most commonly prescribed opioid pain relievers declined slightly in 2012 and remained steady in 2013, showing some signs of progress. • Heroin overdose deaths have been sharply increasing since 2010.

Drug overdose deaths increased significantly from 2013 to 2014. • Increases in opiate overdose deaths were the main factor in the increase in drug overdose deaths. • The death rate from the most commonly prescribed opioid pain relievers increased 9% . The death rate from heroin increased 26% . • • The death rate from synthetic opioids, a category that includes illicitly manufactured fentanyl increased 80% . • Florida ranked # 3 in the nation with 2,634 drug overdose deaths in 2014.

Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida 2008 to 2015 CS-II Dispensing Limits & OxyContin Tamper Resistant Strike Force 900 801 800 715 # “Cause of Death” Occurrences 700 652 House Bill 7095 640 Takes effect 600 533 607 Oxycodone 476 465 500 Methadone 410 380 392 387 400 358 337 336 340 350 Morphine 336 343 279 300 295 274 289 341 300 258 Hydrocodone 239 255 268 219 274 144 201 251 160 238 221 176 176 200 147 142 158 170 142 139 168 Fentanyl 153 133 139 158 152 171 141 100 129 136 136 126 131 129 118 119 108 110 100 85 0 Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2008 - Jun 2015 Reports

Number of Heroin Deaths in Florida: 2000 to 2015* 800 686* 700 # of Heroin Deaths 600 500 447 400 271 250 300 230 208 199 150 200 119 108 109 93 95 78 57 48 100 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H * Projected Increase based on 2 X 1 st Half of 2015 2015 Source: Florida Medical Examiners Commission 2015 Interim Report

Number of Deaths Related to Fentanyl or Heroin in Broward County Florida: 2010-2015 2015 Fentanyl Cases 90 79 98 % Cause of Death 80 91 % w/Other Drugs 70 68 53 60 50 40 Fentanyl Heroin 28 21 30 2015 Heroin Cases 14 20 11 97 % Cause of Death 10 11 85 % w/Other Drugs 5 9 3 0 3 2010 2011 2012 2013 2014 2015 Sources: 2010-2013 FL Medical Examiner Commission Raw Data Tables , 2014 FL Medical Examiner Annual Report, 2015 Data from Broward Medical Examiner Office

CDC Prescribing Guidelines 1. Consider alternative therapies before prescribing opioids. 2. Establish treatment goals before starting opioid therapy. 3. Check in with patients before and during treatment to discuss potential risks and benefits. 4. Prescribe immediate-release opioids vs. extended-release.

CDC Prescribing Guidelines lowest effective dosage acute pain only prescribe a maximum of 3-day supply at the lowest effective dosage prescribing naloxone

CDC Prescribing Guidelines 9. Clinician should review patient history of substance abuse. 10. Clinicians should use urine drug screen before starting opioid therapy. 11. Clinicians should avoid prescribing opioids and benzodiazepines concurrently. 12. Clinicians should offer medication-assisted treatment for an opioid use disorder.

Safe Disposal of Rx Drugs

Overdose Prevention Call 911 Feels like: Looks like: • Slow or no pulse • Slow or no breathing • No energy or strength • Skin is pale and blue, feels cold • Body is limp and can’t wake up/talk • Vomiting • Pupils are pinned or eyes are rolled back • Vomiting

Overdose Prevention for Users • Do use less. Fentanyl, a powerful opioid, has been contributing to the increase in overdoses. • Do sample small dose before use. • Do eat regularly.

Overdose Prevention for Users • Don’t mix drugs and alcohol • Don’t use from an unknown source • Don’t share needles

Overdose Prevention: Naloxone

Overdose Prevention: Naloxone

Overdose Prevention: The Good Samaritan Act

Overdose Prevention: Naloxone Training for Families and Paramours

Overdose Prevention: Post Overdose Reversal • First responders should take patient to the Emergency Department immediately. • Refer to treatment

How Do Address the Treatment Shortage ? Beds Chairs

Treatment: Medication-Assisted Treatment Stabilize brain chemistry Relieve physiological cravings

Myths: Medication-Assisted Treatment 2. Medications are a crutch that prevents true recovery from addiction. 4. Courts are in as good of a position as a doctor to determine the appropriate treatment for a person’s addiction.

Harm Reduction: Syringe Exchange Programs Dozens of scientific studies conducted over the last 20 years, including from the Center for Disease Control and the National Institute for Health, irrefutably demonstrate that syringe exchange programs (SEPs) can play an important role in reducing HIV and viral hepatitis C infection and advancing public safety, especially for law enforcement officials . These studies establish that SEPs do not increase crime or drug use, and provide a gateway to drug treatment and infectious disease prevention.

Myths: Syringe Exchange Programs • 1. Syringe Exchange Programs (SEPs) promote drug abuse. • 3. SEPs increase crime

Strategies from Cities around the U.S Multnomah County, Oregon: - Increased use of the PDMP: More than 99% of pharmacies are required to report, under mandatory Oregon law. - Advocacy for statewide adoption of the CDC prescribing guidelines - Syringe Exchange Programs and Naloxone Trainings

Strategies from Cities around the U.S Manatee County, Florida: - Increased access to treatment - Change in Marchman Act Protocol - Hospitals to provide safe Rx disposal information at discharge, including Deterra disposal bags. - Education to the community and physicians regarding Naloxone

Strategies from Cities around the U.S Gloucester, Massachusetts: - ANGEL Amnesty program at Gloucester Police Department - Rx Prescription Medication Disposal Program - Overdose prevention education, referrals and services

www.drugfreebroward.org www.samhsa.gov

https://healthygloucestercoalition.wordpress.com/programsevents/ http://gloucesterpd.com/addicts/ https://public.health.oregon.gov/About/Pages/ship-substance-use.aspx http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/Fact% 20Sheets/PDMP_2015v02262015.pdf http://www.drugfreemanatee.org/ https://store.samhsa.gov/shin/content/SMA09-4443/SMA09-4443.pdf www.drug freebroward.org http://www.cdc.gov/drugoverdose/prescribing/guideline.html https://www.drugabuse.gov/publications/research-reports/prescription- drugs/opioids/what-are-opioids