Harm Reduction Strategies: The Humane Approach to Addictive Disorders Donna M. White RN, PhD, CS, CADAC Addiction Specialist, Lemuel Shattuck Hospital; Clinical faculty, MGH Institute of Health Professions and University of Massachusetts/Boston Fellow -American Academy of Experts in Traumatic Stress Fellow – International Nurses Society on Addictions Learning Objectives 1. Describe addiction with current trends of use and related terminology that are applicable to all professionals in healthcare. 2. Describe harm reduction techniques to utilize when working with clients, families, and community services. 3. Demonstrate use of naloxone administration during overdose of opioid. 4. Discuss strategies for treatment and referral when dealing with substance abuse problems. 1
Resources • Hazelden Foundation-Publishing • ASPMN -Position Statement in Patients with Addictive Disease 1-888-342-7766 ( www. aspmn .org) • Morgan, Betty (2005) “Knowing How to Play the Game” • American Society of Addiction Medicine (www.asam.org) • www.PainEDU.org • www.masspaininitiative.org • Harm Reduction Coalition (http://harmreduction.org) 2
Learning Objectives Recognize current trends of prescription drug diversion. 2016 DEA Update: Examine recent civil cases involving Audits, Inspections, and registrants. Staying Compliant Discuss nationwide prescription drug take back initiative and disposal options. Summarize recent changes to laws and regulations for controlled substances. Mark Rubbins, Diversion Group Supervisor Drug Enforcement Administration New England Field Division 2 Diversion of Controlled Substances – You Don’t Need The Stats… • We are flooded with pain meds, benzo’s, etc. – which are contributing to increased demand for heroin • Addiction to pain meds is a growing problem and affects everyone everywhere • Cheap, available heroin – for some, the next step after addiction to pills • Opioids are the new targets of regulations, enforcement, treatment • Many of us may know a friend, co‐worker, relative who was treated for pain – and turned into a user 3 4 Public Health Epidemic 2000 -2014: Unintentional drug overdose deaths in the US increased 137% , which was a 200% increase in overdose deaths involving opioids. 500,000 deaths due to prescription overdose 2015: Over 47,000 drug-related overdose deaths 28,647 deaths involved opioids, including heroin 19,000 deaths involved prescription opioid 1 death every 11.16 minutes 46 deaths by end of today’s session (8 hours) 129 deaths every 24 hours CDC National Center for Health Statistics/Morbidity and U.S. Drug Enforcement Administration 5 Morality Weekly Report (MMWR); January 1, 2016 Office of Diversion Control 1
National Overdose Deaths National Overdose Deaths Number of Deaths from Benzodiazepines Number of Deaths from Heroin 12,000 9,000 Total Female Male Total Female Male 8,000 10,000 7,000 8,000 6,000 5,000 6,000 4,000 4,000 3,000 2,000 2,000 1,000 0 0 Source: National Center for Health Statistics, CDC Wonder Prescription Opioid Analgesics Poisoning Deaths Prescription Opioid Analgesics Poisoning Deaths U.S. Drug Enforcement Administration Office of Diversion Control Abuse Facts 2013 Partnership Attitude Tracking Study In 2014, 27 million Americans aged 12 or older Troubling data on misuse/abuse of prescription were current (past month) users of illicit drugs narcotics and stimulants 1 in 10 Americans Every day 2,700 teens try a controlled 6.5 million used prescription-type medication to get high for the first time psychotherapeutic drugs (any pain relievers, tranquilizers, stimulants or sedatives) for non- Perception of teens toward this misuse/abuse medical purposes in a one-month period very concerning (2011 data – 6.1 million) Misconception of the dangers of these 4.3 non-medical users of pain killers substances Non medical use of prescription type drugs is Parental attitudes are contributing to the second only to marijuana problem – major disconnect!! SOURCE: 2014 National Survey on Drug Use and Health (NSDUH) published September 2014 by the Dept of HHS/ Substance Abuse and Mental Health Services Administration (SAMHSA) 12 13 1 SOURCE: 2013 PATS, Partnership for a Drug-Free America and MetLife Foundation, published September 2014 2
2013 Partnership 2013 Partnership Attitude Tracking Study Attitude Tracking Study Many teens mistakenly believe that Problematic, cavalier attitude regarding pharmaceuticals are safer than “street drugs” misuse/abuse of Rx drugs for a variety of reasons: One in eight teens (about 2.7 million) reports They’re “medicine” having abused or misused the stimulants Ritalin Obtained from doctors, pharmacies, friends or or Adderall family members – non threatening 31% of teens believe that prescription It is not necessary to buy them from traditional stimulants can be used as an effective study “drug dealers” – after all, they came from a aid doctor, right? 1 SOURCE: 2013 Parents and Teens Attitude Tracking Study Report, Partnership for a Drug-Free America and MetLife 1 SOURCE: 2012 Parents and Teens Attitude Tracking Study Report, Partnership for a Drug-Free America and MetLife 14 15 Foundation, published July 22, 2014 Foundation, published July 22, 2014 2013 Partnership The ‘OXY’ SUBCULTURE Attitude Tracking Study 73% of teens say its easy to access Rx drugs from their parents’ medicine cabinet 38% of teens who have misused Rx drugs obtained them from parents’ medicine cabinet 23% said parents would not care as much if they were caught abusing Rx meds as compared to illicit drugs 1 SOURCE: 2013 Parents and Teens Attitude Tracking Study Report, Partnership for a Drug-Free America and MetLife 16 Foundation, published July 22, 2014 Pain Clinic “Clients” “No Florida Id Required” WHY? At least they also offer Detox too! 19 3
Corresponding Responsibility by Pharmacist’s Corresponding Pharmacist Responsibility The responsibility for • CFR §1306.04.(a) “ … a corresponding the proper prescribing responsibility rests with the pharmacist who and dispensing of fills the prescription. An order purporting to be controlled substances a prescription issued not in the usual course pf professional treatment….is not a prescription is upon the prescribing within the meaning and intent of section 309 of practitioner, but a the Act, and the person knowingly filling such a corresponding purported prescription, as well as the person responsibility rests with issuing it, shall be subject to the penalties the pharmacist who fills provided for violations of the provisions of law the prescription. relating to controlled substances.” 21 CFR § 1306.04(a) U.S. Drug Enforcement Administration Office of Diversion Control Corresponding Responsibility by DEA’s Diversion Control Division Pharmacist Our Mission: A pharmacist, by law, has a corresponding responsibility to • Prevent, detect, and investigate the diversion of ensure that prescriptions are controlled substances (pharmaceuticals, listed legitimate. chemicals) from legitimate channels. When a prescription is presented by a patient or demanded to be filled • Ensure an adequate and uninterrupted supply of for a patient by a doctor’s office, a controlled substances required for legitimate pharmacist is not obligated to fill the medical, commercial, and scientific needs. prescription!!! U.S. Drug Enforcement Administration Office of Diversion Control 25 Diversion Control’s Legal Authority Diversion Legal Authority (cont’d.) CONTROLLED SUBSTANCE ACT REGULATIONS Title 21 Food And Drugs Title 21 Code of Federal Regulations CHAPTER 13 DRUG ABUSE PREVENTION AND CONTROL • Track the flow of controlled substances • 21 United States Code (U.S.C.) identifies the scheduling – Registration of controlled substances – Recordkeeping • Authorizes DEA to register individuals and companies to – Inventories handle controlled substances – Security • Specifies criminal, civil, and administrative sanctions Violations of requirements subject DEA registrants to civil monetary penalties and other sanctions 26 27 4
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