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

The Opiate Epidemic Laura Suminski, MSE, NCC, LPC-IT, SAC-IT Krystle Gutting, MS, LPC-IT, SAC-IT Connections Counseling Madison, WI www.connectionscounseling.com

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

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

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

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.

Faces of Those Affected

Scope of the Problem Increase in Retail Sales 1997 2005 % of Change Methadone 518,737 5,362,815 933% Oxycodone 4,449,562 30,628,973 588% Fentanyl Base 74,086 387,928 423% Hydromorphone 241,078 781,287 244% Hydrocodone 8,669,311 25,803,544 198% Morphine 5,922,872 15,054,846 154% Meperidine 5,765,954 4,272,520-26% Codeine 25,071,410 18,960,038-24% http:www.deadiversion.usdoj.gov/arcos/retail_drug_summary/index.html Table thanks to Marv Seppala, MD, Hazelden Foundation

Counts Increase in Opioid-related Deaths 180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 21 Deaths Overdose Heroin Overdose 31 Drug Overdose and Death Dane County 2007-2011 77 18 18 125 127 27 28 2007 2008 2009 2010 2011 175 Dane County Narcotics & Gangs Task Force 2012

Wisconsin s Opiate-Related Deaths 1999 2006 Centers for Disease Control and Prevention, 2010

Crude rate per 100,000 Poisoning Leading Cause of Death Dane County: Injury Mortality Trends (2000-09) Injury: 3 rd leading cause of all deaths 15 14 13 12 11 10 9.4(40) Motor Vehicle Poisoning Falls Firearms 11.9(57) 9 8 7.7(33) 7.9(38) 7 6 6.9(33) 6.5(31) 5 4 4.7(20) 3 2 1 0 Counts of deaths in parenthesis 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Years PHMDC 2011

Overdose Arrests for Opiates and Hallucinogens Dane County, 2006-2010 Heroin 198(67%) Hallucinogens 12(4%) Methadone 7(2%) Other opiates 79(27%) Source:Dane County Narcotics & Gang Task Force 2011

Crude Rate per 10,000 Opioid-related Hospital Visits Opiate Hospitalization and ED visits Dane County 2002-2010 4.5 4 All Opiates Heroin Other Opiate Drugs 198 3.5 3 125 2.5 2 84 97 1.5 69 1 0.5 19 0 Note: counts of cases at the ends of the lines 2002 2003 2004 2005 2006 2007 2008 2009 2010 Years PHMDC 2012

rate per 10,000 population Opioid-related Hospital Visits 60 55 50 Hospitalization and ED Visits With Poisoning Dane county 2006-2010 Male Female 45 40 35 30 25 20 15 10 5 0 <15 15-24 25-34 35-44 45-54 55-64 65-74 75+ PHMDC 2012

Problematic Areas

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.

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

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.

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

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 http://www.youtube.com/watch?v=u1frpjowtkw Narcan Training Contact: Scott Stokes [Scott.Stokes@arcw.org] SCARE ME Chicago Recovery Alliance

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 reverse opiate overdose ** Some Narcan injections were for accidental or other legitimate medical concerns. Madison Fire & EMS

Questions? Comments? 5005 University Avenue Suite 100 Madison, WI. 53705 Phone: (608) 233-2100 www.connectionscounseling.com

References Baltimore Sun. (March 26, 2005). Retrieved October 23, 2010, from http://www.mapinc.org/ drugnews/v05.n540.a02.html Center for Disease Control (2004). Unintentional and Undetermined Poisoning Deaths ---11 States, 1990--2001. Retrieved October 19, 2010, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5311a2.htm Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death File 1999-2004. CDC WONDER On-line Database, compiled from Multiple Cause of Death File 1999-2004 Series 20 No. 2J, 2007. Accessed at http://wonder.cdc.gov/mcd-v2004.html on Oct 15, 2010 12:04:21 AM SAMSHA. (2003). Drug Abuse Warning Network. Area profiles of drug related mortality. District Of Columbia: Author. Retrieved October 20, 2008, from http://dawninfo.samhsa.gov/files/me_report_2003_state.pdf 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 http://www.drugpolicy.org/about/stateoffices/newmexico/911/ 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), 397-404. 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), 186-193.