opioid misuse & overdose - industrial commission · 2018-09-20 · drug poisoning (overdose)...
TRANSCRIPT
![Page 1: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/1.jpg)
OPIOID MISUSE &
OVERDOSE:
IDAHO’S RESPONSE
Nicole Fitzgerald, MPA, CPSGovernor’s Office of Drug Policy
![Page 2: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/2.jpg)
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016
USE
Idaho ranks 5th in the nation for pain reliever misuse
5%4%
10%
4%5%
12+ 12-17 18-25 26+ 18+
• Idahoans aged 18 to 25 were significantly more likely to report misusing prescription drugs.• Idahoans were more likely to misuse prescription drugs in every age group compared to the
percentage for the United States.
![Page 3: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/3.jpg)
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2015 and 2016
USE
55%
41%
30%28%
14%
8% 7%4% 3% 2% 2%
Alcohol Vape Marijuana Cigarettes Prescription
Drugs
Inhalants Synthetic
Marijuana
Ecstasy Steroid
Pills/Shots
Meth Heroin
OVER 1 IN 7 IDAHO HIGH SCHOOL STUDENTS HAVE EVER MISUSED
PRESCRIPTION DRUGS.
1 IN 50 HAVE TRIED HEROIN
![Page 4: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/4.jpg)
Drug-induced Death
![Page 5: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/5.jpg)
44 4362 56
71 6482 83 88 80 81
93
12316 24
2218
19 33
2739 30 45
59
75
69
3843
4446
58
7771
7065
8471
55
52
0
50
100
150
200
250
300
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Drug Poisoning (Overdose) Deaths, Idaho2004-2016
Opioids involved No opioid involvement Drug(s) not specified
Source: Idaho Bureau of Vital Records and Health Statistics
![Page 6: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/6.jpg)
Source: Idaho Bureau of Vital Records and Health Statistics
![Page 7: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/7.jpg)
Rate of Drug Overdose Deaths reporting Opioid involvement by Public Health District of Residence 2011-2015*
*among Idaho residents
![Page 8: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/8.jpg)
Centers for Disease Control and Prevention, Prescribing Map, 2016
PRESCRIPTIONSIdaho ranks 17th in the nation in the total number of opioid prescriptions
dispensed/100 persons
National average: 66.5/100 personsIdaho rate: 77.6/100 persons
![Page 9: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/9.jpg)
Source: Centers for Disease Control & Prevention, 2016
Variation by county in the total number of opioid prescriptions dispensed/100 persons
PRESCRIPTIONS
![Page 10: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/10.jpg)
9/7/2018 10
Quarterly rate of people with ≥1 opioid prescription per 1,000 Idaho residents, 2016–2017
![Page 11: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/11.jpg)
Resources
Opioid Misuse & Overdose Workgroup & Strategic Planwww.odp.idaho.gov
Idaho’s Response to the Opioid Crisis (IROC)https://healthandwelfare.idaho.gov/ search IROC
To refer anyone to IROC call 1-800-922-3406
Live Better Idahohttps://www.livebetteridaho.org/
2-1-1 HelplineCall 211
Nicole Fitzgerald, [email protected]
208-854-3040
![Page 12: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/12.jpg)
Treatment of Opioid Use DisorderMagni Hamso, MD, MPH
Clinical Assistant Professor,
University of Washington-Boise Internal Medicine Residency
Internal Medicine Physician, TRHS
[email protected] @MagniMD
![Page 13: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/13.jpg)
• No financial disclosures.• Will use generic names when possible.
– Buprenorphine/naloxone instead of Suboxone.– “Bupe” for short.
• Will use PollEverywhere
Disclosures
![Page 14: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/14.jpg)
![Page 15: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/15.jpg)
![Page 16: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/16.jpg)
• Understand the scope of the opioid overdose epidemic
• Define opioids, opioid use disorder (OUD), addiction & recovery
• Identify evidence-based treatments for OUD
• Understand why buprenorphine/naloxone is an effective treatment for OUD
Goals of Talk
![Page 17: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/17.jpg)
![Page 18: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/18.jpg)
![Page 19: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/19.jpg)
![Page 20: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/20.jpg)
![Page 21: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/21.jpg)
• Prescription pain medicines such as hydrocodone (Norco), oxycodone, morphine, fentanyl
• Illegal drugs such as heroin• Stimulate the opioid receptor in the brain to
decrease pain, as side effects make people feel good (euphoria) and slow breathing (overdose risk)
What are Opioids?
![Page 22: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/22.jpg)
![Page 23: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/23.jpg)
![Page 24: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/24.jpg)
• “a primary, chronic disease of brain reward, motivation, memory, and related circuitry…
• …pathologically pursuing reward and/or relief of withdrawal symptoms by substance use…
• …Without treatment or engagement in recovery, addiction is progressive and can result indisability and death.”
What is Addiction?
![Page 25: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/25.jpg)
Slide Credit: Dr. John Giftos, Clinical Director SUD Treatment, Correctional Health Services
![Page 26: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/26.jpg)
Slide Credit: Dr. John Giftos, Clinical Director SUD Treatment, Correctional Health Services
![Page 27: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/27.jpg)
Criminal Justice Exposure Common for Patients with Opioid Use Disorder
In addition to fact that
heroin possession/use is
illegal, increased
tolerance and physical
dependence often lead to
criminal activity in order
to sustain drug use.
Slide Credit: Dr. John Giftos, Clinical Director SUD Treatment, Correctional Health Services
![Page 28: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/28.jpg)
• Diagnostic criteria include:
Opioid Use Disorder
Clinical term for the chronic disease of addiction
• escalating use & loss of control• continued use despite negative consequences• diminished ability to fulfill societal obligations• tolerance to the effects of the drug• withdrawal symptoms when the drug is stopped
![Page 29: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/29.jpg)
Who is affected?
![Page 30: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/30.jpg)
• 70 year-old grandfather, relapsed after 40 years
• 28 year-old homeless insulin-dependent diabetic
• 32 year-old pregnant stay-at-home mom on opioids since last c-section
• 50 year-old using painkillers after work injury
• 44 year-old small business owner
Who is affected?
![Page 31: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/31.jpg)
![Page 32: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/32.jpg)
Treatment
Medication Assisted
Treatment
Psychosocial Interventions
Housing, Employment,
Mental Healthcare
Recovery Support
Harm Reduction
![Page 33: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/33.jpg)
• Practical strategies & ideas aimed at reducing negative consequences of drug use–Meeting users where they are at– Substance use a continuum – from severe
use to abstinence–Complete abstinence not always the goal– Empower & give voice to people who use
drugs
Harm Reduction
![Page 34: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/34.jpg)
• Safe injection technique
• Clean needles
• HIV, Hepatitis C testing
• Hepatitis A & B vaccination
• Naloxone (Narcan) for reversal of opioid overdose
Harm Reduction
![Page 35: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/35.jpg)
• “a process of sustained action that addresses the biological, psychological, social and spiritual disturbances…
• aims to improve the quality of life...
• is the consistent pursuit of abstinence”
What is Recovery?
![Page 36: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/36.jpg)
Treatment
Medication Assisted
Treatment
Psychosocial Interventions
Housing, Employment,
Mental Healthcare
Recovery Support
Harm Reduction
![Page 37: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/37.jpg)
Medication Assisted Treatment
![Page 38: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/38.jpg)
Opioid Agonist Therapy
Methadone Buprenorphine
Opioid Antagonist
Extended-release
Naltrexone
Medication Assisted Treatment
![Page 39: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/39.jpg)
BupPractice 2013.
Medication Assisted Treatment
![Page 40: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/40.jpg)
Opioid Antagonist Therapy
Opioid Antagonist
Extended-release
Naltrexone
• Once monthly intramuscular injection
• Blocks intoxicating/reinforcing effects of opioids
• Some interest pre-release
• High relapse rates, limited evidence
• Increased risk of overdose after antagonist wears off
![Page 41: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/41.jpg)
Opioid Agonist Therapy
Opioid Agonist Therapy
Methadone Buprenorphine
Reduce withdrawal symptoms & cravings
prevent relapse allow brain to heal
↓mortality ↓ HIV/HCV ↓ substance use
↓ criminal activity ↑retention in treatment
![Page 42: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/42.jpg)
Opioid Agonist Therapy
Opioid Agonist Therapy
Methadone Buprenorphine
Reduce withdrawal symptoms & cravings
prevent relapse allow brain to heal
![Page 43: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/43.jpg)
BupPractice 2013.
Medication Assisted Treatment
![Page 44: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/44.jpg)
Methadone vs Buprenorphine
Methadone Buprenorphine
Full agonist Partial agonist
Typical dose 80-120mg/d Typical dose 16mg/d
Treatment Program (daily dosing)
Office based (prescription)
Stigma Managed like any other chronic illness
More risky, especially during induction phase
Protected from overdose(ceiling effect, tight bond to receptors)
Better for patients who need more structure, heavier opioid use
Bound to naloxone to prevent diversionand misuse
![Page 45: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/45.jpg)
Slide Credit: Dr. John Giftos, Clinical Director SUD Treatment, Correctional Health Services
![Page 46: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/46.jpg)
Retain in Treatment, Prevent Relapse
Kakko et al. Lancet 2003; 361: 662-8.
![Page 47: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/47.jpg)
Fielin et al. JAMA 2014; 174(12): 1947-54.
Retain in Treatment, Prevent Relapse
![Page 48: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/48.jpg)
Reduce HIV, HCV
Tsui et al. JAMA 2014; 174(12): 1947-54.
70% lower risk of acquiring hepatitis C on methadone or buprenorphine
![Page 49: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/49.jpg)
Reduce Mortality
Schwartz et al. AJPH 2013; 103: 917-22.
![Page 50: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/50.jpg)
• Recent meta-analysis showed reduction in all-cause mortality and overdose-related mortality
– Three times higher mortality rate out of methadone treatment
– Five times higher overdose mortality rate out of methadone treatment
Sordo et al. BMJ 2017; 357: j1550.
Reduce Mortality
![Page 51: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/51.jpg)
Buprenorphine Treatment
Day 1: Intake (counselor & MD visit, agreement, urine
drug screen, PMP, labs)
Home Induction Day 4: MD visit
Week 1: MD & counselor visit Week 2/3/4: MD & counselor visit
Week 6/8: MD & counselor visit
Urine drug screens each visit. Monthly visits once patient doing well.
Recommend LONG TERM treatment, typically a year or longer; some need lifelong treatment.
![Page 52: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/52.jpg)
![Page 53: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/53.jpg)
• Naloxone for reversal of opioid overdose on site and easily accessible
• Information about how to access care
• Support staff struggling with opioid use disorder, as would support employees with other chronic medical conditions
• Ensure coverage of substance use disorders and mental health care
What can employers do?
![Page 54: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/54.jpg)
![Page 55: OPIOID MISUSE & OVERDOSE - Industrial Commission · 2018-09-20 · Drug Poisoning (Overdose) Deaths, Idaho 2004-2016 Opioids involved No opioid involvement Drug(s) not specified Source:](https://reader034.vdocuments.mx/reader034/viewer/2022050520/5fa3617fb511ff25be05dc3b/html5/thumbnails/55.jpg)
• https://www.samhsa.gov/medication-assisted-treatment
• https://odp.idaho.gov/opioids-and-overdoses/
• https://www.nsc.org/
Want to learn more?