Ge#ng the Low Down On Prescrip4on Opioids: How to recognize the signs and seek help

Transcription

1 Ge#ng the Low Down On Prescrip4on Opioids: How to recognize the signs and seek help Dr. Melanie Willows Clinical Director Substance Use and Concurrent Disorders Program Dr. Kim Corace Project Director, Regional Opioid Intervention Service Substance Use and Concurrent Disorders Program January 17, 2013

2 Learning points The current state of prescrip4on opioid abuse and addic4on in Ontario How to recognize when you or someone you love is in trouble with prescrip4on opioids The Royal's new Regional Opioid Interven4on Service to treat opioid addic4on and related mental health issues

3 What is an Opioid? Opioids are depressants they slow down certain brain func4ons Opioids are also referred to as narco4cs Opioids can be effec4ve painkillers Some opioids are prescrip4on medica4ons (like oxys, fentanyl) and others are not (ie., heroin)

4 Prescrip4on Opioid Abuse Opioid abuse is a growing problem Canada is the world s third largest per capita consumer of opioids. Ontario tops the list in Canada Prescrip4on opioids has become the predominant form of illicit opioid use (rather than heroin)

5 Prescrip4on Opioid Abuse cont d Increase in number of individuals seeking treatment for opioid dependence in the last 10 years Opioids are a commonly abused substance by youth and young adults

6 Why Opioids, Why now? Increasing availability of prescrip4on opioids 1977 Oxycodone/Acetaminophen (Percocet) 1989 Hydromorphone Hydrochloride (Dilaudid) 1991 Morphine (MS IR) 1992 Duragesic patch (fentanyl) 1993 Morphine (MS Con4n) 1996 Oxycodone Hydrochloride CR (Oxycon4n) 1996 Duragesic patch added to Ontario Drug Benefits Formulary

7 Why Opioids, Why now? cont d Increasing availability of prescrip4on opioids 2000 Oxycodone IR (Oxycon4n IR) 2000 Oxycodone Hydrochloride CR (OxyconCn) added to Ontario Drug Benefits Formulary 2001 Hydromorphone Hydrochloride (Hydromorph Con4n CR) 2002 Hydromorphone Hydrochloride (Hydromorph IR) 2006 RanFentanyl Patch (generic) added to Ontario Drug Benefits Formulary

8 Why Prescrip4on Opioids? Why now? Think it s safe because it s a prescrip4on More socially acceptable than heroin Purity Strong opioid Easy access Possible to alter how you use it: chew, suck, snort, smoke, inject

9 Commonly Abused Prescrip4on Opioids Drug Name Tylenol #1,2, 3 M Eslon, MS Con4n Percocet OxyNeo, Oxycon4n Dilaudid Duragesic patch AcCve Ingredients Codeine with acetaminophen Morphine Oxycodone with acetaminophen Oxycodone Hydromorphone Fentanyl

10 Table 1. Past Year Drug Use (%) for the Total Sample, and by Sex and Grade, 2011 OSHUHS (CAMH) Total Male Female G7 G8 G9 G10 G11 G12 Alcohol Cannabis Binge Drinking Opioid Pain Relievers (NM) Cigarehes

11 A Genera4on Exposed Although experimenta4on with alcohol and other drugs is a natural part of adolescence, experimenta4on involving opioids is high risk as addic4on occurs much more rapidly than with other drugs» Na4onal Ins4tute of Drug Addic4on (NIDA)

12 Risks of Opioid Misuse Overdose (high risk new users, unknown dose, combined with alcohol and/or benzodiazepines, amer a period of stopping opioids) Death Accidents Addic4on Infec4ous diseases from intravenous use and sharing drug equipment (Hepa44s C, HIV)

13 Opioid Intoxica4on: What do others observe? Drowsiness or the Nod Constricted or pinpoint pupils Slurred speech Impairment in ahen4on or memory

14 Opioid Intoxica4on: What do others observe? Dilated pupils Anxiety, irritability, anger (drug craving) Agita4on & Restlessness (cannot sit s4ll) Appears to be ill: nausea, vomi4ng, diarrhea, sweats and chills, watery eyes, runny nose Yawning Insomnia

15 Not everyone who takes prescribed opioids has a problem... Prescrip4on opioids are effec4ve pain relievers Some people require long term prescrip4on opioids for chronic pain Many people take their opioids as prescribed Experiencing withdrawal symptoms if you stop your prescrip4on opioids abruptly would be expected

16 How do you know you may have a problem? (Drug Abuse Screening Test 10*) 1. Have you used drugs other than those required for medical reasons? 2. Do you abuse more than one drug at a 4me? 3. Are you able to stop abusing drugs when you want to? * DAST 10; H.A. Skinner, 1982

17 How do you know you may have a problem? (Drug Abuse Screening Test 10) cont d 4. Have you ever experienced black outs or flashbacks as a result of your drug use? 5. Do you ever feel bad or guilty about your drug use? 6. Does your spouse (or parents) ever complain about your involvement with drugs? 7. Have you neglected your family because of your use of drugs?

18 How do you know you may have a problem? (Drug Abuse Screening Test 10) cont d 8. Have you engaged in illegal ac4vi4es in order to obtain drugs? 9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? 10. Have you had medical problems as a result of your drug use (e.g. memory loss, hepa44s, convulsions, bleeding)?

19 What are the warning sign that your loved one may have a problem? Missing school or work, change in performance in school or work Change in peer group Money issues, possessions are lost/missing Irritability, mood swings, secre4ve, isola4on Finding drug paraphernalia: 4n foil, needles, straws, empty pens

20 Preven4ng of Opioid Use Problems Delaying onset of all substance use Safe storage of opioids in the home and disposal of opioids once no longer required Treatment of any underlying mental health issues

21 Mental Health and Substance Use People with substance use problems have higher rates of mental health problems than the general popula4on People with mental health problems have higher rates of substance use problems than the general popula4on

22 Mental Health and Substance Use cont d Young people age are more likely to report mental health and/or substance use problems than other age groups Concurrent Disorders = condi4on in which a person struggles with both a mental health and a substance use problem

23 Rates of Concurrent Disorders 40 70% of people with substance use problems have mental health issues Most common combina4ons: Substance use problems + Anxiety disorder Substance use problems + Mood disorder

24 Concurrent Treatment is Key Trea4ng both mental health and substance use problems together = Greater chance of success If mental health and substance use problems are caught and treated early, people have a beher chance of a quicker and fuller recovery

25 Stages of Change Model* *Prochaska & DiClemente Maintenan ce: Change 6 months AcCon: Change <6 months ContemplaCo n: Change date <6 months PreparaCo n: Change date <1 month

26 Regional Opioid Interven4on Service We are one of the first of it s kind in Ontario We provide early interven4on for opioid addic4on on an outpa4ent basis alongside trea4ng mental health problems Our team has many types of health professionals

27 Regional Opioid Interven4on Service cont d We partner with community and hospital service providers to offer a full spectrum of care We provide training and educa4on to health care providers to build capacity to treat opioid addic4on

28 Hub and Spoke Partnership Model

29 Why did we develop the Regional Opioid Interven4on Service? More young people and those using for shorter periods of 4me are seeking treatment Very long wait 4mes for inpa4ent medical detox High rates of concurrent mental health and substance use problems issues, which need to be treated together

30 Why did we develop the Regional Opioid Interven4on Service? Experience/exper4se with the use of opioid subs4tu4on medica4on [Buprenorphine/Naloxone (Suboxone)] Buprenorphine/Naloxone (Suboxone) is an appropriate office based treatment for use by family doctors with training

31 Buprenorphine/Naloxone (Suboxone) Approved in Canada in November 2007 Is a par4al opioid agonist Long ac4ng Tablet taken sublingually under the tongue

32 Buprenorphine/Naloxone (Suboxone) May be safer in overdose than methadone* May be easier to taper off this medica4on than methadone* May be beher for youth, young adults and for early interven4on** High risk of precipitated withdrawal discourages ongoing opioid use *Methadone Maintenance Treatment Program Standards and Clinical Guidelines, 4 th edi4on February 2011 CPSO **Buprenorphine/Naloxone for Opioid Dependence: Clinical Prac4ce Guideline CAMH 2011

33 Regional Opioid Interven4on Service We mainly serve people who are under 30 years old or who have been using opioids for less than five years. Treatments based on your unique needs: Outpa4ent opioid detoxifica4on and maintenance Detox lasts about 3 weeks, and requires you to ahend the program almost every day Mental health assessment and treatment Counseling and case management supports Follow up services

34 How can you par4cipate in the Regional Opioid Interven4on Service? First step is to register and ahend one of our monthly orienta4on sessions OR Contact our addic4on counsellor Family members are encouraged to ahend the orienta4on session. We will provide informa4on on support for family members

35 What happens next? A team member will contact you by phone to ask you some more ques4ons to see if this treatment is a good fit for you If this program does not meet your needs, then we will discuss alterna4ves and help you to access other treatments either here at the Royal or with one of our partners

36 Treatment doesn t end here.. You will need ongoing support to maintain the gains you ve made. Con4nued counseling and support Referral to programs for addic4on and mental health treatment within The Royal and with our community partners

37 What if the treatment doesn t work? Relapse in addic4on is common and does not mean that you should give up Your team will work with you to help determine what the best next step might be

38 What does this new ini4a4ve mean for pa4ents and families? No more knocking on the wrong door, if this service is not a good fit we will help you find the right door in the SUCD program at The Royal or in a community program Customized treatment based on your addic4on and mental health picture Educa4on and support for pa4ents and families

39 What will this mean for the community? Further linkages of community agencies Forma4on of links between family doctors and community addic4on and mental health agencies Increased capacity of the region to iden4fy and treat opioid addic4on and mental health problems Increased access to addic4on and mental health care for opioid users where they live

40 References Methadone Maintenance Treatment Program Standards and Clinical Guidelines, 4 th edi4on February 2011 CPSO Buprenorphine/Naloxone for Opioid Dependence: Clinical Prac4ce Guideline 2011 (CAMH) Paglia Boak, A, Mann, RE, Adlaf, EM (2011). Drug use among Ontario students, : OSDUHS highlights. (CAMH Research Document Series No. 32). Toronto, ON: Centre for Addic4on and Mental Health. NIDA Na4onal Ins4tute on Drug Abuse Substance Abuse: A Comprehensive Textbook 4th Ed. Lewinson et al. 2005

41 References Principles of Addic4on Medicine 4th ed., American Society of Addic4on Medicine Lowinson & Ruiz s Substance Abuse: A Comprehensive Textbook Fimh Edi4on Chapter 57 Adolescent Substance Abuse R. Milin and S. Walker. Editors Pedro Ruiz &Eric Strain. Lippincoh Williams & Wilkins, Philadelphia, PA, 2011 Skinner, H.A. (1982). The Drug Abuse Screening Test. Addic4ve Behaviors, 7, The DAST 10 was developed and copyrighted by Dr. Harvey A. Skinner, PhD, Department of Public Health Services at the University of Toronto, and the Centre for Addic4on and Mental Health, Toronto, Canada.