effects of the opioid epidemic · common myths about addiction •drug misuse equates to drug...

MISSION: TO PREVENT AND REDUCE SUBSTANCE MISUSE AMONG YOUTH AND ADULTS IN ANDERSON COUNTYMISSION: TO PREVENT AND REDUCE SUBSTANCE MISUSE AMONG YOUTH AND ADULTS IN ANDERSON COUNTY

Jennifer Burnette, MPH

Prevention Coordinator, Media Manager

Effects of the Opioid Epidemic

MISSION: TO PREVENT AND REDUCE SUBSTANCE MISUSE AMONG YOUTH AND ADULTS IN ANDERSON COUNTY

Who We Are

• Non-profit prevention agency

• Established in the fall of 2008 to prevent and reduce substance misuse among youth and adults in Anderson County

• Coalition of volunteers

Youth Parents

Business community

Schools

Youth-serving organizations

Law enforcement

Religious/fraternal orgs

Civic & Volunteer groups

Healthcare

Government

Recovery Community

Objectives

• Identify characteristics of addiction, misuse, and dependence

• Understand chronic aspects of addiction

• Understand the opioid epidemic and impacts on our community

Substance Use DisorderCharacteristics of addiction, misuse, and dependence

Substance Use Disorder

• A brain disease expressed as a compulsive behavior

• The continued abuse of drugs despite negative consequences

• A chronic, progressive, potentially relapsing disorder

Addiction Continuum

Source: Bozarth, Michael, 1990.

Use Misuse Tolerance Dependency Addiction

Common Myths About Addiction

• Drug misuse equates to drug addiction

• Alcohol is not a drug

• Addiction is a moral weakness

• You have to hit rock bottom to recover

• You have to want treatment for it to be successful

• Drug misuse is more common among minorities

MYTHS!

Involves Multiple Factors

Genetics Environment

Brain Mechanisms

Source: National Institute of Drug Abuse, 2008.

Understanding Addiction

Drug Dependence and the Brain

• DOPAMINE• Dopamine functions as a neurotransmitter

• Dopamine has many functions in the brain, including important roles in behavior and cognition, motor activity, motivation and reward, sleep, mood, attention, and learning.

Why is this important?

• Drugs activate the same system activated by natural rewards• BUT…drugs activate the system stronger and longer

• Drugs “hijack” the brains dopamine system and the brain becomes dependent on the drug

Chronic Aspects of Addiction & Recovery

Dr. Monty Burks TN Together: Family Recovery

What Does the Face of Addiction Look Like?

Amy Lambert

Person-First Language

Terms to Avoid Why Preferred Terminology

Addict, abuser, junkie, user Terms are demeaning; label people by their illness or behavior and imply permanency

Person with a substance use disorder

Clean or dirty Associate symptoms with judgment

Negative, non-negative/positive, abstinent, actively using

Habit or drug habit Deny the medical nature of the condition; imply the problem in a matter of willpower

Substance use disorder, regular substance use

Can brains recover from drug dependence?

• Some characteristics of addiction are similar to other chronic diseases• It is preventable

• It is treatable

• It changes biology

• If untreated, it can last a lifetime

The Brain in Recovery, Recovery Research Institute 2019, https://www.recoveryanswers.org/recovery-101/brain-in-recovery/

Relapse Does Not Mean Failure

TN Treatment and Recovery Resources

• Tennessee REDLINE (1-800-889-9789)• Toll-free info and referral line• Provides up-to-date information

• Project Lifeline

• Medication Assisted Treatment

• Recovery Housing

• Recovery Congregations

• & More

https://www.tn.gov/behavioral-health/substance-abuse-services.html

Effects of the Opioid Epidemic

What is a prescription opioid?

• Powerful pain-reducing medication

• Has benefits and risks• Can manage pain• Can cause serious harm, addiction, overdose, and death

• Commonly misused opioids• Hydrocodone• Fentanyl• Vicodin• Lortab• OxyContin• Heroin

Credit: © Bruce A. Taylor/NH State Police Forensic Lab

How do opioids work?

• Bind to receptors in the brain and spinal cord, disrupting pain signals

• Activate reward areas of the brain by releasing the hormone dopamine, creating a feeling of euphoria

Pain Pathways and Treatment

• Nociceptive (caused by an injury, physical pressure, or inflammation of some part of the body)• NSAIDs, Acetaminophen, Opioids – least effective and greatest side effect

• Neuropathic (caused by damage or disease affecting the somatosensory nervous system)• NSAIDs, Anti-epileptics

• Central Sensitization (condition of the nervous system that is associated with the development and maintenance of chronic pain where the nervous system gets wound up and maintains a persistent state of high reactivity) ie: Fibromyalgia, IBS• No medications (Maybe antidepressants)

Rate of Death in Tennessee Higher than National Average

Source: CDC, Data Visualization Gallery, Drug Poisoning, 2015.

Opioid Increase in Utilization

• Drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg of morphine per person in 1997

• Increased to approximately 640 mg per person in 2015• Increase of >500%

That is the equivalent of 128 Vicodin tablets!

Increases in Prescribing Rates

Source: NIDA, Opioid Summaries by State, 2018.U.S. County Prescribing Rates, 2017, CDC https://www.cdc.gov/drugoverdose/maps/rxcounty2017.html

Findings: Increased opioid prescribing associated with elevated mortality.

Timeline of the Opioid Crisis

• 1861-1865: morphine used as battlefield anesthetic during Civil War; many soldiers became dependent after the war

• 1898: Heroin is first produced commercially by Bayer Company; believed to be less habit-forming than morphine

• 1914: Congress passes Harrison Narcotics Act; requires doctors write prescriptions for narcotic drugs (like opioids and cocaine); US Treasury taxes products

• 1924: Anti-Heroin Act bans sale of heroin in US

• 1970: Controlled Substances Act becomes law

Timeline of the Opioid Crisis…

• 1980: A letter titled “Addiction Rare in Patients Treated with Narcotics” published in the New England Journal of Medicine (not a study but widely cited as proof narcotics were safe)

• 1990s: AMA recognizes pain as 5th vital sign (blood pressure, heard rate, respiratory rate, temperature); adopts PROP (Physicians for Responsible Opioid Prescribing—funded by Phoenix House, which runs a chain of treatment centers)

• 1990s: Medicare has a funding formula that requires hospitals to prove they provide good care through patient satisfaction surveys. The formula rewards hospitals that are rated highly by patients, while penalizing those that are not.

• 1995: OxyContin introduces and aggressively marketed as safer pain pill by Purdue Pharma

• 2007: Federal government brings criminal charges against Purdue Pharma for misleading adverting practices; execs plead guilty and pay $634.5 M in fines (sentenced to probation)

• 2016: CDC publishes guidelines for prescribing opioids for chronic pain; AMA drops pain as vital sign

• 2018: Medicare changes patient satisfaction surveys, drops pain treatment satisfaction for reimbursement

• 2018: (March) Trump administration outlines initiative to stop opioid misuse; includes law enforcement and interdiction, prevention and education via an ad campaign, and job-seeking assistance

• 2018: (March) Year-long study published in Journal of the American Medical Association concluding opioids were no more effective against common forms of pain than acetaminophen

• 2018: (April) Surgeon General issues advisory recommending Americans carry naloxone (the last SG advisory issued more than a decade ago focused on drinking during pregnancy)

Acute Use Leads to Long-Term Use

• Duration of acute use:• 1 day – 6% chance of still using that drug a year later

• 8 days – 13.5%

• 31 days – 29.9%

East TN RegionTn.Gov Data Dashboard

• 14% of patients filling an opioid Rx for pain had at least one overlapping benxzodiazepine Rx

• Overlapping opioids/benzodiazepines most common drug classes involved in Rx overdose deaths

• Rate of 1,281 filled Rx/1,000 people in 2017

• Top 3 Prescription

• Hydrocodone

• Oxycodone

• Tramadol

East Tennessee RegionTN.Gov Data Dashboard

• 9966 patients filling buprenorphine prescriptions for medication-assisted treatment (MAT)

• Additional information available on www.tn.gov TN Drug Overdose Dashboard

Impact

• 130+ people die every day in the U.S. from opioid pain medications (that’s 47,450 people every year) (HHS, 2017)

• 70% people who abused prescription painkillers reported getting them from friends or relatives

• Estimated cost of medical care and treatment for opioid dependence is $78.5 B annually (Medical Care Journal, 2013)

Life Expectancy

• U.S. life expectancy decreased for the first time in decades

• U.S. mortality rate increased

• All driven by opioid overdoses! • Declined again in 2017

Opioid overdoses counteracted all other medical advances!

The Good News

• In 2013, Tennessee had 1,334 MME per capita• Equivalent to 133 pills of 10 mg Hydrocodone per person

• In 2017, Tennessee had 913 MME per capita• Equivalent to 91 pills of 10 mg Hydrocodone per person

• Decrease of -32%

MISSION: TO PREVENT AND REDUCE SUBSTANCE MISUSE AMONG YOUTH AND ADULTS IN ANDERSON COUNTYSource: Prescription Nation: Addressing America’s Drug Epidemic. National Safety Council, 2016.

Alternatives to Opioids for Pain

• Acetaminophen/Ibuprofen (NSAID) combination

• Acupuncture

• Massage Therapy

• Meditation

• Chiropractic Care

• Mindfulness-Based Stress Reduction

• Physical Therapy

• Eye Movement Desensitization and Reprocessing

Shameless Plug!

Opioid Alternatives Lunch and Learn Series at Methodist Medical

Center

Search for Opioid Alternatives on Eventbrite.com to Register or visit

ASAPofAnderson on Facebook

Combination of 200mg IBU and 500 mg ACETO more efficacious than any opioid

Cochrane Reviews, National Safety Council

Ibuprofen 200mg

Acetaminophen500 mg

Ibuprofen 400mg

Oxycodone 15mg

Oxy 10 + acet1000

Ibu 200 + acet500

Percent with 50% pain relief

Opportunities

• What YOU can do:• Utilize and recommend alternative pain treatment approaches

• Screening Questions

• Count It, Lock It, Drop It

• Encourage families to talk about substance misuse – it’s part of PREVENTION!

• Be an advocate

• Reduce stigma

• Connect with your local Coalition• https://www.tn.gov/behavioral-health/substance-abuse-

services/prevention/prevention/join-an-anti-drug-coalition0.html

Follow ASAPofAndersonon your favorite social media sites

www.ASAPofAnderson.org

865-457-3007

ASAPofAnderson@gmail.com

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