EPIDEMIC 4.6 % OF INDIVIDUALS USED PAIN RELIEVERS FOR NON-MEDICAL REASONS. 1.5 MILLION YOUNG ADULTS USED PAIN RELIEVERS IN THE PAST MONTH.

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4 EPIDEMIC In the 10 years ( ) the per capita retail purchases of Methadone, Hydrocodone and Oxycodone in the United States increased 13-fold, 4-fold and 9-fold, respectively. 4.6 % OF INDIVIDUALS USED PAIN RELIEVERS FOR NON-MEDICAL REASONS. 1.5 MILLION YOUNG ADULTS USED PAIN RELIEVERS IN THE PAST MONTH. 5.2 MILLION AGE 12 YEARS AND OLDER USED PRESCRIPTION MEDICINE NON-MEDICALLY IN THE PAST MONTH.

5 The drug of choice for adolescences Age is no longer marijuana, but prescription drugs from family, friends and others. Nationally, Unintentional drug poisoning deaths increased 68% during During 1999 to 2004, West Virginia experienced the nation s most substantial increase (550%) in unintentional poisoning mortality. EPIDEMIC

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7 Health Problems/Suicide Attempts: More than 150,000 students develop an alcohol-related health problem (Hingson et al., 2002) and between 1.2 and 1.5% of students indicate that they tried to commit suicide within the past year due to drinking or drug use (Presley et al., 1998) Drunk Driving: 2.1 million students between the ages of 18 and 24 drove under the influence of alcohol last year (Hingson et al., 2002) Alcohol Abuse and Dependence: 31% of college students met criteria for a diagnosis of alcohol abuse and 6% for a diagnosis of alcohol dependence in the past 12 months, according to questionnaire-based self-reports about their drinking (Knight et al., 2002)

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9 The financial cost of substance abuse in West Virginia is more than $1.8 billion each year!!! Of every dollar spent on substance abuse in West Virginia, 99.6 cents goes to shoveling up the wreckage of substance abuse and only.4 cents is used to prevent and treat it!! AHHHHHH!

10 2006 CDC reported excessive consumption cost the US $223.5 billion dollars. It is responsible for 79,000 deaths per year Breakdown of Costs: 72% Loss of Workplace Productivity 11% Health care expenses 9% Law Enforcement/Criminal Justice 6% Motor Vehicle Accidents

11 Ten percent of American adults consider themselves to be in recovery from drug or alcohol abuse problems. Approximately 23.5 million

12 Addictions occur when behaviors start to become excessive. They are driven by our systems that stand up, shake us and say, The brain is saying this is good; we should do it again. Joseph Frascella, Director, Clinical Neuroscience, NIDA Addiction is a chronic and relapsing brain disease characterized by uncontrollable drugseeking behavior and use. It persists even with the knowledge of negative health and social consequences Scott Lukas, Mclean Hospital

13 Addiction has a specific definition: you are unable to stop when you want to, despite being aware of adverse consequences. It permeates your life; you spend more and more time satisfying your craving. In the brains of addicts, there is reduced activity in the prefrontal cortex, where rational thought can override impulsive behavior. Dr. Nora Volkow, NIDA

14 Addiction is not just about substances. Addiction is about disrupting the process of pleasure; the balance point is shifted so you keep creating more and more urges, and you keep wanting more and more. Dr. Martin Paulus, Professor of Psychiatry, UCSD

15 Chronic Illness Model

16 1-Tolerance 2-Withdrawal 3-Loss of control over amount of alcohol consumed 4- Preoccupation with controlling drinking 5-Preoccupation with drinking activities 6- Impairment of social, occupational, or recreational activities 7-Use is continued despite persistent problems related to drinking

17 1. Recurrent substance use resulting in a failure to fulfill major role, obligations at work, school, or home. 2. Recurrent substance use in situations which is physically hazardous 3. Recurrent substance-related legal problems 4. Continued substance use despite having persistent or recurrent social or in

18 1. Tolerance as defined by either of the following: a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect. b. Markedly diminished effect with continued use of the same amount of the substance.

19 2. Withdrawal as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance b. The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts or over a longer period than was intended.

20 4. There is persistent desire or unsuccessful efforts to cut down or control substance use. 5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover fro its effects. 6. Important social, occupational, or recreational activities are given up or reduced. 7. Substance use is continued despite knowledge of having persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

21 Cut down Anger Guilt Eye Opener % sensitive

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26 MU Receptors : * Endorphins * Morphine, Codeine * Heroin * Naloxone, Narcan * Naltrexone, revia * Alcohol (indirect) GABA Receptors: * Benzodiazepines * Barbiturates * Sedative Hypnotics * Alcohol

27 Naltrexone is a drug designed to BLOCK the effects of narcotics in the body. That s it. To be a bit more precise, it blocks the receptors which are stimulated by narcotics or similar substances. It is not a pain reliever. It does not have any other known benefits beyond those produced by blocking he effects of narcotics. If you have Naltrexone in your system and you take a narcotic the narcotic will not work, it will not produce the desired effect. Moreover, if you are currently dependent on any narcotic, taking Naltrexone will typically produce withdrawal symptoms.

28 Prescribing Considerations Frequency of Administration Restrictions on Prescribing or Dispensing Abuse and Diversion Potential Additional Requirements Extended-Release Injectable Naltrexone Intramuscular injection in the gluteal muscle Prescribed by licensed person and administration by qualified staff Buprenorphine Oral tablet or Film. Taken at physicians office or home Licensed physicians who are DEA registered No. Yes. Yes None Physicians must complete training Methadone Oral-witnessed at OTP or take home doses Licensed physicians who are DEA registered Only can be dispensed by

29 What prescriptions contain Naltrexone?

30 The therapeutic effects of Naltrexone are mediated by blockade of central mu opioid receptors. The site of action is under investigation but evidence supports a role of mu receptors in the central nucleus of the amygdala, nucleus accumbens, and ventral tegmental area in the therapeutic actions of Naltrexone for alcohol dependence.

31 Nalrexone, an Antagonist for the Treatment of Heroin Dependence

32 What Role Can Extended-Release Injectable Naltrexone Play in the Treatment of Opioid Dependence?

33 How does extended-release injectable Naltrexone differ from other forms of MAT Opiod Dependence? How does it work? Are there safety concerns? Which patients may benefit most? Can it be used with behavioral therapies? How can pain be treated during use of Naltrexone?

34 CLINICIAN S OBSERVATIONS CLIENTS SELF-REPORT

35 Full Treatment Experience (Detoxification; Rehabilitation; Maintenance) General Population relapse at 1 yr Physicians Recover at 1 year Detoxification Alone at < 1 year

36 Questions and/or Discussion

37 For additional questions you may contact me: Dr. Edward Eskew, DO 4307 MacCorkle Avenue Charleston, West Virginia Office: (304)

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