The Opiate Epidemic. Laura Suminski, MSE, NCC, LPC-IT, SAC-IT Krystle Gutting, MS, LPC-IT, SAC-IT

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1 The Opiate Epidemic Laura Suminski, MSE, NCC, LPC-IT, SAC-IT Krystle Gutting, MS, LPC-IT, SAC-IT Connections Counseling Madison, WI

2 The Opiate Epidemic Opioid-related Facts Scope of the Problem Symptomology Effective Treatment Strategies Community Efforts

3 Opioid-related Facts Attractive to the eye; soothing to the smell

4 Opiate Drug Classification Pharmaceutical Opioids Codeine Hydrocodone (Vicodin) Morphine Oxycodone (Oxycontin, Percocet) Methadone (synthetic) Suboxone (Buprenorphine and Naloxone) Opium Heroin Illicit Opiates

(Oxycontin, Percocet) Methadone (synthetic) Suboxone

5 Opioid Abuse/Dependence Why Are Opiates Frequently Abused? Opioids are prescribed therapeutically to relieve pain, but when opioids activate these reward processes in the absence of significant pain, they can motivate repeated use of the drug simply for pleasure.

opioids activate these reward processes in the absence of

6 Faces of Those Affected

7 Scope of the Problem Increase in Retail Sales % of Change Methadone 518,737 5,362, % Oxycodone 4,449,562 30,628, % Fentanyl Base 74, , % Hydromorphone 241, , % Hydrocodone 8,669,311 25,803, % Morphine 5,922,872 15,054, % Meperidine 5,765,954 4,272,520-26% Codeine 25,071,410 18,960,038-24% Table thanks to Marv Seppala, MD, Hazelden Foundation

25,803,544 198% Morphine 5,922,872 15,054,846 154% Meperidine 5,765,954 4,272,520-26% Codeine 25,071,410

8 Counts Increase in Opioid-related Deaths Deaths Overdose Heroin Overdose 31 Drug Overdose and Death Dane County Dane County Narcotics & Gangs Task Force 2012

31 Drug Overdose and Death Dane County 2007-2011 77 18 18 125 127 27 28

9 Wisconsin s Opiate-Related Deaths Centers for Disease Control and Prevention, 2010

10 Crude rate per 100,000 Poisoning Leading Cause of Death Dane County: Injury Mortality Trends ( ) Injury: 3 rd leading cause of all deaths (40) Motor Vehicle Poisoning Falls Firearms 11.9(57) (33) 7.9(38) (33) 6.5(31) (20) Counts of deaths in parenthesis Years PHMDC 2011

4(40) Motor Vehicle Poisoning Falls Firearms 11.9(57) 9 8 7.7(33) 7.9(38) 7 6 6.9(33) 6.

11 Overdose Arrests for Opiates and Hallucinogens Dane County, Heroin 198(67%) Hallucinogens 12(4%) Methadone 7(2%) Other opiates 79(27%) Source:Dane County Narcotics & Gang Task Force 2011

12 Crude Rate per 10,000 Opioid-related Hospital Visits Opiate Hospitalization and ED visits Dane County All Opiates Heroin Other Opiate Drugs Note: counts of cases at the ends of the lines Years PHMDC 2012

5 4 All Opiates Heroin Other Opiate Drugs 198 3.5 3 125 2.5 2 84 97 1.

13 rate per 10,000 population Opioid-related Hospital Visits Hospitalization and ED Visits With Poisoning Dane county Male Female < PHMDC 2012

Poisoning Dane county 2006-2010 Male Female 45 40 35 30

14 Problematic Areas

15 Symptomology Symptoms of Opioid Abuse/Dependence: Contracted pupils Nodding out, difficulty keeping their eyes open Slurred speech Scratching Fidgeting Mood swings Opiates can be taken orally, crushed into powder, or injected.

eyes open Slurred speech Scratching Fidgeting Mood

16 PAWS Immediate Withdrawal: Short-lived Acute Intense immediate withdrawal which occurs directly after stopping all opiates Duration: Post Acute Withdrawal Syndrome (PAWS) This is the more drawn-out phase of withdrawal...as the body & brain learn to cope without drugs. Duration: 3 to 10 days Begins 60 days into sobriety and can last for 2 yrs. Symptoms: "Clucking Shakes Profuse sweating Chills Gooseflesh Body temperature instability Autonomic instability "Revved-up Diarrhea Cramping Bone pain Mental anguish Symptoms: Mood swings Anxiety Irritability Tiredness Variable energy Low enthusiasm Variable concentration Disturbed sleep

Duration: 3 to 10 days Begins 60 days into sobriety and can last for 2 yrs.

17 Opiates and Neurobiology Opiates mimic naturally occurring peptide substances in the brain that act as neurotransmitters with opiate activity called endorphins. Natural endorphins of the brain act to kill pain, cause sensations of pleasure, and cause sleepiness. It is believed that morphine and heroin combine with the endorphin receptors in the brain, resulting in reduced natural endorphin production. As a result, the drugs are needed to replace the naturally produced endorphins and addiction occurs.

Natural endorphins of the brain act to kill pain, cause sensations of pleasure, and cause sleepiness.

18 Effective Treatment Counseling Services Individual & Group Medication Management Suboxone Vivitrol (Naltrexone) Methadone Family Therapy NARANON N.A. Meetings / SMART Recovery Mentor Support / Peer Support Sober Events

(Naltrexone) Methadone Family Therapy NAR

19 Community Efforts Medication Drop Locations Pharmacy Tracking Drug Poisoning Summit Efforts Good Samaritan Law Needle Exchange Narcan (Naloxone) LIVE! Using Injectable Naloxone to Reverse Opiate Overdose Narcan Training Contact: Scott Stokes SCARE ME Chicago Recovery Alliance

Using Injectable Naloxone to Reverse Opiate Overdose http://www.youtube.com/watch?

20 Good Samaritan 911 Law Provides limited immunity from prosecution from possession of small amounts of drugs and/or alcohol for those who call for medical assistance for themselves or someone else in the event of an overdose. Most overdose deaths Occur in the presence of friends and/or family Take place 1-3 hours after drug use 911 is not called Tobin Study Strang, 2005; Szczepanski, 2007; Tobin, 2005; Wagner, 2010

Increasing Number of EMS Calls Largest group each year among 20-29 year olds 9-30, 2012: 542 * Narcan mostly used to

21 Increasing Number of EMS Calls Largest group each year among year olds 9-30, 2012: 542 * Narcan mostly used to reverse opiate overdose ** Some Narcan injections were for accidental or other legitimate medical concerns. Madison Fire & EMS

22 Questions? Comments? 5005 University Avenue Suite 100 Madison, WI Phone: (608)

23 References Baltimore Sun. (March 26, 2005). Retrieved October 23, 2010, from drugnews/v05.n540.a02.html Center for Disease Control (2004). Unintentional and Undetermined Poisoning Deaths States, Retrieved October 19, 2010, from Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death File CDC WONDER On-line Database, compiled from Multiple Cause of Death File Series 20 No. 2J, Accessed at on Oct 15, :04:21 AM SAMSHA. (2003). Drug Abuse Warning Network. Area profiles of drug related mortality. District Of Columbia: Author. Retrieved October 20, 2008, from Strang, J., Kelleher, M., Best, D., Mayet, S., & Manning, S. (2005). Preventing opiate overdose deaths with emergency naloxone medico-legal consideration of new potential providers and contexts. British Medical Journal. Szczepanski, R. (2007). Drug Policy Alliance New Mexico: 911 Good Samaritan Law. Retrieved October 19, 2010, from Tobin, K. E., Davey, M. A., & Latkin, C. A. (2005). Calling emergency medical services during drug overdose: an examination of individual, social and setting correlates. Society for the Study of Addiction, 100(3), Wagner, K. D., Valente, T. W., Casanova, M., Partovi, S. M., Mendenhall, B. M., Hundley, H. H., & Gonzalez, M. (2010). Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. International Journal of Drug Policy, 21(3),

A Local Multifaceted, Multidisciplinary Approach to Opiate Overdose & Death

A Local Multifaceted, Multidisciplinary Approach to Opiate Overdose & Death 2013 WPHA-WALHDAB Annual Conference Wednesday, May 22: 2:00-2:35 pm Lisa Bullard-Cawthorne, MS, MPH OPIATE PREVALENCE IN DANE