Join Mary Kirkwood, MD, psychiatrist, to learn more about addiction medicine and how Agnesian HealthCare is prepared to help the heroin epidemic in our county. Hear from two recovering heroin addicts about their journey and how Agnesian HealthCare is supporting them on their path to recovery.

1. Heroin/Pain Pill
(Opioid) Addiction
Mary Kirkwood, MD, Psychiatrist
Board Certified: Psychiatry &
Addiction Medicine
Agnesian HealthCare

2. Heroin/Pain Pills = Opioids
What are Opioids?
Medication/substances that bind to the mu opioid
receptor in the brain.
People experience less pain, but may also
experience euphoria, sedation, nausea and impaired
decision making. Too much opioid can cause
someone to stop breathing and die.
Examples: hydrocodone (Vicodin),
oxycodone (Percocet), morphine,
codeine, fentanyl, heroin

3. Symptoms of Opioid Addiction
Tolerance and withdrawal
Inability to cut down/control use
Much time spent using/obtaining/recovering
from opioids
Strong craving to use opioids
Inability to attend to responsibilities at
school/work/home
Use in dangerous situations (driving)

4. Severity of Opioid Addiction
Mild: Two to three symptoms
Moderate: Four to five symptoms
Severe: Six or more symptoms

5. Heroin/Pain Pill Addiction
How does it start?
Complicated or multiple surgeries, or for chronic
pain syndromes.
Others are offered pain pills at parties to get high.
After using the pills on a chronic basis, patients
get ill from withdrawal when they don’t have
pills.
Patients can’t function at work or with their
families when they are so sick, so they look for
pain pills wherever they can get them.

6. Heroin/Pain Pill Addiction
Post Acute Withdrawal
Psychological withdrawal symptoms
that last for up to two years, including
irritability, anxiety, tiredness, poor
concentration and disturbed sleep.
This makes quitting opiates/heroin very difficult.
The temptation to take heroin/pain pills again to
relieve these symptoms is hard to resist.

7. Why Heroin?
Doctors are prescribing fewer pain pills
because of addiction risk.
Pain pills are more expensive and harder
to find in the community.
People in withdrawal are turning to
heroin because it is cheaper and easier to
find.

8. Heroin/Pain Pill Addiction
What is the best way to help?
Medication
Counseling
Family/friend support

9. Heroin/Pain Pill Addiction
Medication Assisted Treatment
Opioid Replacement = Suboxone and
Methadone
Opioids specifically designed to treat addiction to
help control withdrawal and cravings.
Non-opioid replacement = Naltrexone
Helps with cravings, but not withdrawal.
Lower success rate than suboxone/methadone.

10. Heroin/Pain Pill Addiction
Suboxone versus Methadone
Both eliminate withdrawal
Both control cravings
Suboxone: patients rarely develop tolerance
Can be prescribed 30 days at a time
Methadone: tolerance is common
Requires daily dispensing at special clinic

11. Which Works Best?
Both suboxone and methadone decrease
risk of relapse.
Methadone has a slightly higher retention
rate.
Naltrexone also decreases the risk of
relapse, but more people drop out of
treatment on naltrexone versus suboxone
and methadone.

12. Which Is Safest?
Methadone has a higher rate of lethal
overdose than suboxone.
Suboxone is less likely to be injected.
Naltrexone is the safest of all since there
is no overdose risk.

13. Heroin/Pain Pill Addiction
Counseling
Medication alone is not enough. Individual
and group counseling help patients learn how
to cope in everyday life without drugs.
Family Support
Family/friends can help by understanding the
need for intensive treatment, which in most
cases includes medication.

14. Pregnant Patients
The most recommended treatment is suboxone or
methadone.
On these medications, women have lower relapse
rates, attend more prenatal visits, and can provide
a more stable home life for their baby.
Attempting to detox a woman completely from
opioids increases the risk of
miscarriage…suboxone and
methadone decrease that risk.

15. Overdose
Death is by respiratory failure - they stop
breathing.
Between 2006 and 2011, there were no deaths
by suspected overdose in Fond du Lac.
2012 = 1 death
2013 = 4 deaths
The number one cause of accidental death in
the United States is due to poisonings/
overdoses (most commonly opiates).
2014 = 3 deaths
2015 = 12 deaths

16. People Are Dying
Deaths by opioid overdoses tripled from
between 1999 and 2013.
Between 2010 and 2013 opioid pain pill
deaths stabilized,
but heroin opioid
deaths increased by
37 percent per year.

17. Risk Factors for Overdose
Opioids plus sedatives and/or alcohol
Recent abstinence: results in decreased
tolerance
Use of illegal opioids, especially when
injected
Lung disease/sleep apnea

18. What is Narcan?
Narcan is a medication that rapidly reverses
the effects of opioid overdose.
Comes in a shot form and a nasal spray.
Communities that distribute Narcan have
lower rates of death by opioid overdose.
Can be given by people in the community
when an overdose is suspected.

19. Signs of an Overdose
The person is non responsive
The person isn’t breathing or doesn’t have a
pulse
The person has a blue cast to lips or
fingertips
Small pupils

20. Narcan to Prevent Overdose
Who is a candidate for a Narcan
prescription?
Anyone diagnosed with opioid addiction
Anyone receiving or stopping medication
treatment with methadone or suboxone
Anyone at risk of decreased tolerance,
including people released from jail who have
a history of opioid addiction
Family or friends of an individual with any
of the above characteristics

21. Narcan Availability
Available by prescription as injection and nasal
spray at most pharmacies
Agnesian pharmacies have Narcan available by
prescription; hope to have over-the-counter
soon

22. This Is a National Epidemic
President Obama participated in the National
Rx Drug Abuse and Heroin Summit in Atlanta,
Georgia
Increase the patient limit for doctors who prescribe
suboxone from 100 to 200
Increase in funding
 Underserved communities
 For the distribution of Narcan
 Investigate the distribution of pills/heroin
 Provide clean syringes to IV drug users to decrease
risk of HIV/hepatitis

23. Help at National Level
Medicare, Medicaid and Marketplace
insurance plans will be required to increase
access to opioid addiction treatment.
The Center for Disease Control and
Prevention has issued guidelines to primary
care providers.
Black box warning for fast acting opioids,
warning about the risks of abuse, addiction
and overdose death.

24. Addiction Treatment at
St. Agnes Hospital
Call (920) 926-4200 to schedule an addiction
assessment.
Most patients attend our day treatment
program, which lasts anywhere from two to
five days, from 8 a.m. to 4 p.m.
During day treatment, most patients are
started on suboxone and participate in groups
on education about addiction and coping skills.

25. Addiction Treatment at
St. Agnes Hospital, cont.
After day treatment, the patient participates in
individual counseling, group counseling, and
sees a psychiatrist for the suboxone.
Patients are encouraged to attend Narcotics
Anonymous and get a sponsor.
Treatment with suboxone can last for as long as
the patient needs it.
Patients successfully weaned from suboxone
are encouraged to continue with Narcotics
Anonymous (NA) and individual counseling.

26. Addiction Treatment at
St. Agnes Hospital, cont.
Naltrexone (medicine that helps with
cravings but isn’t an opiate) is also available
to patients.
Treatment for depression, anxiety and other
mental health issues.

27. Resources
To find information about opioid addiction
treatment outside of Agnesian HealthCare:
 http://www.methadoneclinicusa.com
 http://dpt2.samhsa.gov/treatment/directory.aspx
 http://www.suboxone.com/treatment-plan/find-a-
doctor
 http://www.buprenorphine-doctors.com/find-a-
doctor.cfm

28. Kellie

29. Before Addiction
 Childhood
 Loving family
 Good grades

30. High School
 New friends
 Experimentation
 Maintained good
grades

31. Progression of Addiction
Desire to use kept
increasing
Didn’t understand
addiction
Hard to save money
Employment suffered to
Use Kept

32. Heroin
Justifications
 Cheaper
 Easiest to obtain
 It’s OK as long as I’m not shooting up like
a “junkie”
 Escalated quickly

33. Six Months Clean…Relapse

34. Rock Bottom
 Arrested June 8, 2014
 Serious legal problems
 Facing possible prison

35. In jail I found out I was pregnant.

36. Recovery
 June 8, 2014
 August 2014 - Treatment at St. Agnes
Hospital Behavioral Health Services
 Actively involved in Narcotics Anonymous
(NA)

37. Healthy Baby Girl –
November 17, 2014

38. Today
Legal issues resolved
Employed

39. Awesome Family Support

41. I’m Kellie.
Recovering addict with 1 year
and 11 months clean/sober.

42. My Life. . . . . . . . . . . . . . . . . . . . . .
Wendy McGurk

43. The Beginning
My father was an alcoholic
Thought everyone grew up around alcohol/normal
He was an angry drunk
My parents divorced when I was nine
Felt very isolated
Had to move
Started changing
My mother introduced new husband

44. Adolescence
Started drinking at 14
First time I got wasted
Tried marijuana, cocaine
New group of friends
Stopped caring about school and family
Very rebellious/started running away
By 16, I was drinking every weekend and could
drink eight to 10 beers

45. Growing Pains
By 17, I had to sit in jail
First thoughts I might have a problem
Straightened out, got it together and graduated
Found a job serving tables
At 18 enrolled in college
Struggled to get homework done due to drinking
Dropped out after 1-½ years from alcohol use
Still serving tables and drinking four to five nights a
week – 12 pack of beer

46. Stepfather Dies
At age 22, my stepfather died
Was introduced to opiates, painkillers
Best feeling ever
Was hooked right away
Was using regularly to numb pain
Lost my job
Lost my apartment
Moved back home

47. Addiction
Could not stop
Obsession of the brain/all I thought about
Nobody trusted me anymore
Went from boyfriend to boyfriend to support habit
Started drinking when I did not have pills to avoid
withdrawal
Tried to quit and failed
Was using around 10 to 15 15mg Percocet daily
Thought I was going to die/contemplating suicide

48. Healing
St. Agnes for help/inpatient program
Totally surrendered and was willing to do
anything to get help
Started suboxone program
Within the first week I felt changes
Obsessive thinking was gone
Had clear thoughts
Did not want to take all of my medication
Started therapy
Gave my life over to the care of God

49. Recovery
In the first year of sobriety I got married,
had a baby and started school
I graduated from Moraine Park with high
honors in December 2014 with my
Associates Degree and SAC-IT
Bachelors from Viterbo end of 2016

51. Recovery
I now have a loving family
I have confidence in myself
I want to give what has been given to me
Believe that addiction
is a disease that I need
to manage daily
Life CAN change

52. Thank You!