It is our group presentation in Mount Sinai.

1. Drug abuse a public
health concern
Opioid drug abuse and
its implications

2. Big changes and
impacts on the drug
epidemic started
during the 1990s.

3. Lack of pain
treatment =
The fifth vital sign:
Pain
“With the concern for the under management of pain, Dr. James
Campbell in his 1995 Presidential Address to the American
Pain Society, presented the idea of evaluating pain as a vital
sign” (Campbell JN. APS 1995 Presidential address. Pain Forum.
1996;5:85–8)
Different health organizations caught on and it
became mandatory to assess and treat pain
accordingly.

4. Opioid production/
marketing on the
rise.
“misbranding OxyContin by claiming that it was less
addictive and less subject to abuse and diversion than
other opioids” (Van Zee).
Purdue/Oxycontin
- The most
influential and
popular
pharmaceutical
company and
substance.

5. The “perfect
combination” for the
start of a substance
abuse epidemic

6. Where do we stand
now?
Hope ruined for a
decrease in
substance abuse
and related health
consequences

7. Current interventions:

8. Current interventions

9. Current interventions : International level

10. The best
interventions
Addressing the market and distribution of illicit
drugs:
● Nearly all opium drugs are trafficked
through Mexican-based drug
organizations
● At the United Nations General Assembly
Special Session (UNGASS) on the world
drug problem in April 2016, the United
States reaffirmed the responsibility for
countering transnational organized drug
crime involvement.
● The Administration also is working closely
with China to reduce the production and
distribution of precursor chemicals.
Ref: https://www.state.gov/documents/organization/268025.pdf
https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-
research/2016_ndcs_final_report.pdf

11. Implementation International counternarcotics training
By International Narcotics and Law Enforcement
Affairs (INL)
Implemented by
● Drug Enforcement Administration (DEA),
● Federal Bureau of Investigation (FBI),
● Immigration and Customs Enforcement
(ICE), U.S. Customs and Border Patrol
(CBP), and
● U.S. Coast Guard(USCG)
https://www.state.gov/documents/organization/2680
25.pdf

12. Federal
Agencies &
Related Links
White House
● Office of National Drug Control Policy
(ONDCP)
Department of Justice (DOJ)
● Drug Enforcement Administration (DEA)
● Federal Bureau of Investigation (FBI)
● National Criminal Justice Reference
Service
Department of Health&Human Services
(HHS)
● Food & Drug Administration (FDA)
● National Institute on Drug Abuse (NIDA)
● Substance Abuse & Mental Health Service
Administration (SAMHSA)

13. Success of DEA Successes in the Fight Against Drugs Impact on Demand
(2000 through 2015)
● Teen drug use: It is estimated that nearly 690,000
fewer teenagers used illicit drugs last year than a
decade earlier, a 15 percent decline.
● Marijuana: use by teens has dropped 14 percent.
Methamphetamine: use by teens has dropped 80
percent.
● Ecstasy: has been slashed by 67 percent among
teens.
● Cocaine: high school seniors has dropped 59
percent, crack cocaine use has decreased 53
percent..
● LSD: dropped by an astounding 50 percent
https://www.dea.gov/resource-center/2015_successes.pdf
https://www.dea.gov/resource-center/2015_successes.pdf
https://www.dea.gov/resource-center/2015_successes.pdf
https://www.dea.gov/resource-center/2015_successes.pdf

14. At the level of
prescribers
Early diagnosis of substance abuse
Referral to Opioid Treatment Programs
Washington State’s implementation of
evidence-based dosing and best-
practice guidelines
Improving adherence to Prescription
Drug Monitoring Program.

15. Family support As a parent what we should do:
● Establish and maintain good
communication with your child.
● Get involved in your child’s life
● Make clear rules and enforce them
consistently.
● Be a positive role model.
● Monitor your child’s activities.
● Teach your child to choose friends
wisely
https://store.samhsa.gov/shin/content//SMA17-3772/SMA17-3772.pdf

16. Treatment and
rehabilitation
MAT
● Methadone, Buprenorphine, Naltrexone,
● Counseling and Behavioral Therapies
● Education
Effectiveness
● Improve patient survival
● Increase retention in treatment
● Decrease illicit opiate use
● Increase employment
● Improve birth outcomes in pregnancy

18. References
Centers for Disease Control and Prevention (CDC) (2017) Prescription opioid overdose data. Retrieved from
https://www.cdc.gov/drugoverdose/data/overdose.html
Centers for disease control and prevention (CDC) (2017) Opioid overdoses: State successes. Retrieved rom
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553643/
Compton, W. M. (2017) National institute on drug abuse Research on the Use and Misuse of Fentanyl and Other Synthetic Opioids. Retreived
from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2017/research-use-misuse-fentanyl-other-synthetic-
opioids
Guy, G., Zhang, K., Bohm, MK., Losby, J., Lewis, B., Young, R., Murphy, L.B., and Dowell, D. (2017) Vital Signs: Changes in Opioid
Prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:697–704. DOI:
http://dx.doi.org/10.15585/mmwr.mm6626a4.
Haffajee, R. L., Jena, A. B., and Weiner, S. G. (2015). Mandatory Use of Prescription Drug Monitoring Programs. JAMA, 313(9), 891–892.
http://doi.org/10.1001/jama.2014.18514
Hawk, K. F., Vaca, F. E., & D’Onofrio, G. (2015). Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies.
The Yale Journal of Biology and Medicine, 88(3), 235–245. Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553643/
Morone and Weiner (2013). Pain as the fifth vital sign: Exposing the vital need for pain education. Clinical Therapeutics, 35(11), 1728–1732.
http://doi.org/10.1016/j.clinthera.2013.10.001
Morbidity and Mortality Weekly Report (2012) Community-Based Opioid Overdose Prevention Programs Providing Naloxone-United States
2010, 61(06);101-105 Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm?s_cid=mm6106a1_w#tab
NIDA. (2015). Prescription opioids and heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/prescription-opioids-
heroin on

19. O’Donnell. J., Halpin, J., Mattson, C., Goldberger, B., Gladden, M., (2016) Morbidity and Mortality Weekly Report Deaths Involving
Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, November 3, 2017 / Vol. 66 / No. 43. Retrieved from
https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6643e1-H.pdf
Rudd, R., Seth, P., David, F., and Scholl L. (2016) Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015.
MMWR Morb Mortal Wkly Rep, 65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1
The Substance Abuse and Mental Health Services Administration (2017). Medication-assisted treatment (MAT) and opioid treatment
programs (OTPs). Retrieved from https://www.samhsa.gov/rss
United Nations Office on Drugs and Crime (2015) World Drug Report 2015. Retrieved from
http://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf
United States Department of State (2017). Bureau for international narcotics and law enforcement affairs International narcotics control
strategy report: Drug and chemical control 1. Retrieved from https://www.state.gov/documents/organization/268025.pdf
Van Zee, A. (2009). The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy. American Journal of Public
Health, 99(2), 221–227. http://doi.org/10.2105/AJPH.2007.131714
Volkow (2014) Senate Caucus on International Narcotics Control hearing America’s Addiction to Opioids: Heroin and Prescription Drug
Abuse retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-
heroin-prescription-drug-abuse#_ftn30
Wachino (2016) Centers for Medicare & Medicaid Services. Best Practices for addressing Prescription Opioid Overdoses, Misuse and
addiction 1-15. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm?s_cid=mm6106a1_w#tab