This document provides information about prescription opioid abuse and addiction. It discusses how opioid abuse has become a growing problem, outlines signs of abuse and addiction, and describes a new regional opioid intervention service that provides outpatient treatment for opioid addiction and concurrent mental health issues. The service offers opioid detoxification, counseling, medication-assisted treatment with buprenorphine, and coordination with other community supports and providers. The goal is to expand access to early intervention and specialized treatment for opioid addiction, especially among youth.
Drug Awareness Program- Say No to Drugs.NITI Aayog
The Department of Administrative Reforms & Public Grievances, Government of India, organized the 2nd 'District Collectors Conference', which took place on the 6th & 7th of September in New Delhi. Over 30 district collectors participated, making presentations on best practices to overcome challenges faced in the sectors of rural development, education, urban development, law & order, and disaster management.
The Planning Commission is providing these presentations for the public to see examples of the good work being done by young IAS officers in the field, and to promote cross-learning and innovation.
Drug Awareness Program- Say No to Drugs.NITI Aayog
The Department of Administrative Reforms & Public Grievances, Government of India, organized the 2nd 'District Collectors Conference', which took place on the 6th & 7th of September in New Delhi. Over 30 district collectors participated, making presentations on best practices to overcome challenges faced in the sectors of rural development, education, urban development, law & order, and disaster management.
The Planning Commission is providing these presentations for the public to see examples of the good work being done by young IAS officers in the field, and to promote cross-learning and innovation.
Opioid addiction is one of the strongest one and it has to be addressed early so that doctors can plan better approaches for faster recovery. But people who are addicted to opioids hardly admit the fact. If you are guessing that someone close to you is behaving oddly and develop other symptoms that you haven’t noticed before, you need to play a role in helping your friends come out of the opioid addiction.
For more information please visit our site: www.opiatecare.com
Understanding And Addressing Nicotine Addiction: A Science-Based Approach to ...Center on Addiction
Nicotine is a highly addictive substance that not only perpetuates tobacco use, the leading cause of preventable morbidity and mortality in the United States, but also has its own adverse effects. Nicotine addiction is a chronic and relapsing disease and the prevalence of nicotine addiction is higher than that of alcohol and other drug addiction. The use of nicotine-containing products not only is associated with developing nicotine addiction, but also with using and becoming addicted to alcohol and other drugs.
Despite the decline in recent years in the use of cigarettes, the use of alternative, non-cigarette nicotine products has been rising dramatically. While the overall harm of these products appears to be considerably lower than the harms associated with cigarette use, all nicotine-containing products carry the risk of addiction and other adverse health effects and, therefore, are a threat to the public health.
Class 12 CBSE Biology Investigatory project on the topic "Drug Addiction" which includes the appropriate format and content for the CBSE practical examinations.
Austin Journal of Drug Abuse and Addiction is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of drug abuse and addiction treatment.
The renowned team of guest editors ensures a balanced, expert assessment of the articles published, with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in the areas of addiction treatment.
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.
Opioid addiction is one of the strongest one and it has to be addressed early so that doctors can plan better approaches for faster recovery. But people who are addicted to opioids hardly admit the fact. If you are guessing that someone close to you is behaving oddly and develop other symptoms that you haven’t noticed before, you need to play a role in helping your friends come out of the opioid addiction.
For more information please visit our site: www.opiatecare.com
Understanding And Addressing Nicotine Addiction: A Science-Based Approach to ...Center on Addiction
Nicotine is a highly addictive substance that not only perpetuates tobacco use, the leading cause of preventable morbidity and mortality in the United States, but also has its own adverse effects. Nicotine addiction is a chronic and relapsing disease and the prevalence of nicotine addiction is higher than that of alcohol and other drug addiction. The use of nicotine-containing products not only is associated with developing nicotine addiction, but also with using and becoming addicted to alcohol and other drugs.
Despite the decline in recent years in the use of cigarettes, the use of alternative, non-cigarette nicotine products has been rising dramatically. While the overall harm of these products appears to be considerably lower than the harms associated with cigarette use, all nicotine-containing products carry the risk of addiction and other adverse health effects and, therefore, are a threat to the public health.
Class 12 CBSE Biology Investigatory project on the topic "Drug Addiction" which includes the appropriate format and content for the CBSE practical examinations.
Austin Journal of Drug Abuse and Addiction is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of drug abuse and addiction treatment.
The renowned team of guest editors ensures a balanced, expert assessment of the articles published, with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in the areas of addiction treatment.
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.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502.
Presentation by Gary M. Franklin, MD, MPH, Research Professor for the Departments of Environmental Health, Neurology, and Health Services University of Washington
Medical Director
Washington State Department of
Labor and Industries
Reuben Strayer on Opioids - Pain, Compassion, Addiction, MalingeringSMACC Conference
Opioids are extraordinary agents that have been used for millennia for the relief of pain and suffering; however, the history of opioids is also one of abuse and addiction. In the US, we are in the midst of a devastating iatrogenic chapter in this history, a prescription opioid epidemic that kills 15,000 Americans per year by overdose and destroys hundreds of thousands of lives and families.
In this presentation we will consider the magnitude and consequences of the current epidemic; describe how clinical organizations and clinicians were appropriated by the pharmaceutical industry so that Americans–5% of the world’s population–consume more prescription opioids than the rest of the world combined; and discuss strategies for managing patients who present to emergency departments with acute or chronic pain complaints that account for our competing mandates to palliate and protect.
These strategies center on an assessment of the likelihood that using opioids will deliver benefit or cause harm. For patients at low risk to be harmed by opioids, utilize aggressive multimodal analgesia, including opioids as needed to control acute pain, and prescribe optimal outpatient non-opioid analgesia with a small number of breakthrough opioids if indicated. For patients at high risk to be harmed by opioids, including patients with chronic pain and patients with flags for opioid misuse, avoid using opioids in the ED and outpatient settings, utilize non-opioids to manage symptoms, and, when misuse is suspected, nudge the patient to addiction treatment. The goals of optimal opioid stewardship are to provide effective symptom relief while preventing de novo cases of addiction, to control the supply of opioids in the community, and to protect existing addicts from further harm while promoting recovery.
For slides, the HELPCard treatment referral business card, and phraseology to use when managing patients at risk for opioid misuse, go to http://emupdates.com/help
The term opioid refers to a group of compounds that includes opium, opium derivatives, and synthetic substitutes. Opioids exert both a sedative and an analgesic effect, and used to relieve pain, cough and treatment of diarrhea. They induce a pleasurable effect on the CNS that promotes abuse. These drugs are capable of inducing tolerance and physiological and psychological addiction.
At ALANA Recovery Centers, we put clients first. Utilizing traditional, evidence-based therapeutic practices and behavioral therapies, we help clients create new strategies to strengthen and sustain lasting recovery. With the help of an expert therapy team, we empower people suffering from drug and alcohol addiction while addressing physical, mental, and emotional needs in a comprehensive, compassionate outpatient setting.
Our in-depth mental health and behavioral treatment programs offer personal, multidisciplinary, holistic treatment options designed to help clients improve emotional regulation, strengthen coping skills, and develop strategies for successful recovery.
With a client-first approach, we are committed to your successful recovery. Our therapists will create a personalized recovery plan that is just as unique as you are. From traditional, evidence-based behavioral therapies to meditation and mindfulness counseling, we offer a holistic approach to drug and alcohol addiction treatment.
Sugar Hill Medication-Assisted Treatment Plans
Our Intensive Outpatient Program (IOP) offers an intensive outpatient addiction treatment option with the flexibility to continue with regular life, including work and school commitments. Ideal for clients who have successfully completed detox and reached an appropriate level of stability, intensive outpatient treatment provides strong foundations for long-term recovery. Individual counselors, local clinicians, and peer support groups work together to offer the insight and skills necessary to help clients remain abstinent from drugs and alcohol.
Buford Intensive Outpatient Program
Our Intensive Outpatient Program (IOP) offers an intensive outpatient addiction treatment option with the flexibility to continue with regular life, including work and school commitments. Ideal for clients who have successfully completed detox and reached an appropriate level of stability, intensive outpatient treatment provides strong foundations for long-term recovery. Individual counselors, local clinicians, and peer support groups work together to offer the insight and skills necessary to help clients remain abstinent from drugs and alcohol.
Alcohol Addiction Treatment
Alcoholism is a chronic disease that results in physical and emotional dependency on alcohol. Alcohol abuse can cause devastating, lasting consequences in your career, personal life, and relationships. Our addiction recovery center in Sugar Hill provides specialized alcohol addiction treatment with outpatient alcohol rehab options that give clients the support and structure they need while working and living at home.
Gwinnett Prescription Opiate Addiction Treatment
Frequently prescribed in chronic pain treatments, opioids can be highly addictive. Our health team uses a harm reduction approach to successfully treat opioid addiction and withdrawal. ALANA prescription drug addiction therapy offers compassionate, caring treatment in an outpatient setting.
The opioid crisis in the United States continues to wreak havoc, especially in the case of prescription opioid painkillers. Learn more about these dangerously addictive drugs and how you can seek help for yourself or a loved one. Learn more at https://www.crystalrunhealthcare.com/specialties/behavioral-health
Workshop for the 5th Annual Addictions and Mental Health Ontario Conference, Canada
Weekly reports of opioid overdoses. Residential treatment providers refusing people on methadone. Supervised injection services. Confusion about naloxone. We will go back to basics, examine the situation we are in, explore misunderstandings, misconceptions and stigma, and discuss progressive programming, linkages and coordination.
Learning objectives:
- Be more informed about the range of opioid drugs, including substitute therapies
- Consider the negative impacts of misunderstanding and stigma on access to effective supports and treatment options
- Feel more comfortable developing inter-agency/program partnerships
- Discuss why the crisis continues to escalate and keeping things in check
A look at how mental health treatment and research have evolved over the last 10 years and about future possibilities for more effective, personalized treatment approaches.
with Dr. Zul Merali, President and CEO, The Royal's Institute of Mental Health Research
Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.
Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.
The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.
Are you drinking TOO much?
Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.
Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/
While terrorism continues to make headlines around the world, some researchers have suggested that terrorists are mentally ill and have used labels such as psychopathic or sociopathic, narcissistic, paranoid and schizophrenic. Others have argued that there is no evidence to indicate that they are mentally ill, disordered, psychopathic or otherwise psychologically abnormal.
The Royal's Dr. AG Ahmed, Dr. Wadgy Loza and Dr. Pius Adesanmi discuss research findings and reflect on the new meanings and manifestations of terrorism and extremism in Canada and around the world.
Our Conversations lecture 'Hope, Humanity and Empowerment: Strengths-focused Cognitive Behavioural Therapy for Psychosis (& Schizophrenia)' was presented by staff members of the Integrated Forensic, Recovery and Schizophrenia programs at The Royal.
Psychosis can be associated with a variety of mental health problems, including schizophrenia, severe depression, bipolar disorder, anxiety, and post-traumatic stress disorders. While traditional treatments for psychosis have emphasized medication-based strategies, research now suggests that individuals affected by psychosis can greatly benefit from talk therapies such as cognitive behavioural therapy for psychosis (CBTP).
Learn more: www.theroyal.ca
The recent attack in downtown Ottawa has deeply affected our city. We have a powerful desire to stay strong as individuals and as a community yet we are all human so it is natural to feel fear, anxiety and loss after this type of event. Recognizing this, The Royal held a special info session on coping with trauma.
Presenters:
Dr. Jakov Shlik, Clinical Director, Operational Stress Injury Clinic and Anxiety program, The Royal
Michelle Antwi, Operational Stress Injury Clinic, The Royal
Katie Bendell, Operational Stress Injury Clinic, The Royal
As presented at The Royal by:
- Dr. Melanie Willows, Clinical Director, SUCD Program, The Royal
- Dr. Kim Corace, Director, Program Development and Research, SUCD Program, The Royal
Opioid addiction is a large and growing problem affecting our community, especially our young people, women and their families. This session addressed:
· The current state of prescription opioid problems
· Opioid use, abuse, and addiction as it relates to women and parenting
· Risk factors for opioid use about women, with a focus on mental health problems
· Treatment options to help women who struggle with opioid problems
· Reducing the stigma and myths regarding women with opioid use problems
This session included information on the collaborative work being done between The Royal’s Sexual Behaviours Clinic (SBC) and Ottawa Police Service’s High Risk Offender Unit (HROU). Dr. Paul Fedoroff was the moderator and began the presentations with an overview of innovative work being done within the SBC and the common goals of the Clinic and the HROU. Staff Sargent Dana Reynolds and Det. Mark Horton discussed the role of their team in the community based management of high risk sexual offenders. More specifically they discussed the role of the Unit and common legal designations utilized for high risk sexual offenders. Lisa Murphy, M.C.A. provided an overview of sex offender registries (SORs) and public notification and made comparisons between the approaches used in Canada and the United States. A discussion period followed the panel presentations.
As presented by Dr. Mathieu Dufour, Psychiatrist at The Royal, at a special Men's Mental Health Awareness event hosted by The Men's D.E.N. (Depression Education Network).
Dr. Andrew Wiens, Head, Division of Geriatric Psychiatry at The Royal, talks about behaviour issues in dementia at our monthly lecture series, Conversations.
As presented at our Conversations at The Royal on March 20, 2014 by speakers Karen James, Cynthia DuBaie, and Richard Cottingham.
More at www.theroyal.ca
“Love Sense” (written by Dr. Sue Johnson): the revolutionary new science of romantic relationships offers the reader a ground breaking guide to the new science of love and loving that has emerged in the last 15 years. The science allows us not just to “fall” in love but to make sense of and shape our most precious relationships.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
CDSCO and Phamacovigilance {Regulatory body in India}
Getting the low down on prescription opioids: Learn how to notice the signs and seek help
1. Getting the Low Down On
Prescription Opioids: How to
recognize the signs and seek help
Dr. Melanie Willows
Clinical Director
Substance Use and Concurrent Disorders Program
Dr. Kim Corace
Project Director, Regional Opioid Intervention Service
Substance Use and Concurrent Disorders Program
January 17, 2013
2. Learning points
•
•
•
The current state of prescription opioid abuse and
addiction in Ontario
How to recognize when you or someone you love is
in trouble with prescription opioids
The Royal's new Regional Opioid Intervention
Service to treat opioid addiction and related
mental health issues
3. What is an Opioid?
• Opioids are depressants-- they slow down certain
brain functions
• Opioids are also referred to as narcotics
• Opioids can be effective painkillers
• Some opioids are prescription medications (like oxys,
fentanyl) and others are not (ie., heroin)
4. Prescription Opioid Abuse
• Opioid abuse is a growing problem
• Canada is the world’s third largest per capita
consumer of opioids. Ontario tops the list in Canada
• Prescription opioids has become the predominant
form of illicit opioid use (rather than heroin)
• Increase in number of individuals seeking treatment
for opioid dependence in the last 10 years
• Opioids are a commonly abused substance by youth
and young adults
6. Why Prescription Opioids? Why now?
•
•
•
•
•
•
Think it’s safe because it’s a prescription
More socially acceptable than heroin
Purity
Strong opioid
Easy access
Possible to alter how you use it:
chew, suck, snort, smoke, inject
7. Commonly Abused Prescription Opioids
Drug Name
Active Ingredients
Tylenol #1,2, 3
Codeine with acetaminophen
M-Eslon, MS Contin
Morphine
Percocet
Oxycodone with acetaminophen
OxyNeo, Oxycontin
Oxycodone
Dilaudid
Hydromorphone
Duragesic patch
Fentanyl
8. Table 1. Past Year Drug Use (%) for the Total Sample,
and by Sex and Grade, 2011 OSDUHS (CAMH)
Total
Male
Female
G7
G8
G9
G10
G11
G12
Alcohol
54.9
54.6
55.1
17.4
26.4
50.5
59.6
75.5
78.4
Cannabis
22.0
23.0
21.0
2.4
5.9
11.9
23.5
36.8
36.4
Binge
Drinking
22.3
22.7
21.8
1.1
4.1
13.7
24.4
35.3
39.7
Opioid Pain
Relievers
(NM)
14.0
12.9
15.2
8.5
10.9
13.0
14.9
18.0
16.0
Cigarettes
8.7
9.3
8.2
2.8
3.7
10.3
14.5
14.4
9. A Generation Exposed....
• Although experimentation with alcohol and other
drugs is a natural part of adolescence, experimentation
involving opioids is high risk as addiction occurs much
more rapidly than with other drugs
» National Institute of Drug Addiction (NIDA)
10. Risks of Opioid Misuse
• Overdose (high risk new users, unknown dose,
combined with alcohol and/or benzodiazepines, after
a period of stopping opioids)
• Death
• Accidents
• Addiction
• Infectious diseases from intravenous use and sharing
drug equipment (Hepatitis C, HIV)
11. Opioid Intoxication: What do others
observe?
•
•
•
•
Drowsiness or “the Nod”
Constricted or pinpoint pupils
Slurred speech
Impairment in attention or memory
12. Opioid Withdrawal: What can you
observe?
•
•
•
•
Dilated pupils
Anxiety, irritability, anger (drug craving)
Agitation & Restlessness (cannot sit still)
Appears to be ill: nausea, vomiting,
diarrhea, sweats and chills, watery eyes,
runny nose
• Yawning
• Insomnia
13. Not everyone who takes prescribed opioids
has a problem....
• Prescription opioids are effective pain relievers
• Some people require long-term prescription opioids
for chronic pain
• Many people take their opioids as prescribed
• Experiencing withdrawal symptoms if you stop your
prescription opioids abruptly would be expected
14. How do you know you may have a
problem? (Drug Abuse Screening Test-10*)
1. Have you used drugs other than those required for
medical reasons?
2. Do you abuse more than one drug at a time?
3. Are you able to stop abusing drugs when you want
to?
4. Have you ever experienced black-outs or flashbacks
as a result of your drug use?
5. Do you ever feel bad or guilty about your drug use?
* DAST-10; H.A. Skinner, 1982
15. How do you know you may have a
problem? (Drug Abuse Screening Test-10)
6. Does your spouse (or parents) ever complain about
your involvement with drugs?
7. Have you neglected your family because of your
use of drugs?
8. Have you engaged in illegal activities in order to
obtain drugs?
9. Have you ever experienced withdrawal symptoms
(felt sick) when you stopped taking drugs?
10. Have you had medical problems as a result of your
drug use (e.g. memory loss, hepatitis, convulsions,
bleeding)?
16. What are the warning sign that your loved
one may have a problem?
• Missing school or work, change in performance in
school or work
• Change in peer group
• Money issues, possessions are lost/missing
• Irritability, mood swings, secretive, isolation
• Finding drug paraphernalia: tin foil, needles, straws,
empty pens
17. Prevention of Opioid Use Problems
• Delaying onset of all substance use
• Safe storage of opioids in the home and
disposal of opioids once no longer required
• Treatment of any underlying mental health
issues
18. Mental Health and Substance Use
• People with substance use problems have higher
rates of mental health problems than the general
population
• People with mental health problems have higher
rates of substance use problems than the general
population
• Young people age 15-24 are more likely to report
mental health and/or substance use problems than
other age groups
• Concurrent Disorders = condition in which a person
struggles with both a mental health and a substance
use problem
19. Rates of Concurrent Disorders
• 40-70% of people with substance use problems
have mental health issues
• Most common combinations:
– Substance use problems + Anxiety disorder
– Substance use problems + Mood disorder
20. Concurrent Treatment is Key
• Treating both mental health and substance use
problems together = Greater chance of success
• If mental health and substance use problems are
caught and treated early, people have a better chance
of a quicker and fuller recovery
21. Stages of Change Model*
Maintenance:
Change
6 months
PreContemplation
Contemplation:
Change date <6
months
Preparation:
Change date <1
month
*Prochaska & DiClemente
22. Regional Opioid Intervention Service
• We are one of the first of it’s kind in Ontario
• We provide early intervention for opioid addiction on
an outpatient basis alongside treating mental health
problems
• Our team has many types of health professionals
• We partner with community and hospital service
providers to offer a full spectrum of care
• We provide training and education to health care
providers to build capacity to treat opioid addiction
23.
24. Why did we develop the Regional Opioid
Intervention Service?
• More young people and those using for shorter
periods of time are seeking treatment
• Very long wait times for inpatient medical detox
• High rates of concurrent mental health and
substance use problems issues, which need to be
treated together
25. Why did we develop the Regional Opioid
Intervention Service?
• Experience/expertise with the use of opioid
substitution medication [Buprenorphine/Naloxone
(Suboxone)]
• Buprenorphine/Naloxone (Suboxone) is an
appropriate office based treatment for use by family
doctors with training
27. Buprenorphine/Naloxone (Suboxone)
• May be safer in overdose than methadone*
• May be easier to taper off this medication than
methadone*
• May be better for youth, young adults and for early
intervention**
• High risk of precipitated withdrawal discourages
ongoing opioid use
*Methadone Maintenance Treatment Program Standards and Clinical Guidelines, 4th
edition February 2011 CPSO
**Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline CAMH
2011
28. Regional Opioid Intervention Service
• We mainly serve people who are under 30 years old
or who have been using opioids for less than five
years.
• Treatments based on your unique needs:
– Outpatient opioid detoxification and maintenance
• Detox lasts about 3 weeks, and requires you to attend the program
almost every day
– Mental health assessment and treatment
– Counseling and case management supports
– Follow up services
29. How can you participate in the Regional
Opioid Intervention Service?
• First step is to register and attend one of our monthly
orientation sessions
OR
• Contact our addiction counsellor
• Family members are encouraged to attend the
orientation session. We will provide information on
support for family members
30. What happens next?
• A team member will contact you by phone to ask you
some more questions to see if this treatment is a
good fit for you
• If this program does not meet your needs, then we
will discuss alternatives and help you to access other
treatments either here at the Royal or with one of
our partners
31. Treatment doesn’t end here…..
You will need ongoing support to maintain the gains
you’ve made…….
• Continued counseling and support
• Referral to programs for addiction and mental health
treatment within The Royal and with our community
partners
32. What if the treatment doesn’t work?
• Relapse in addiction is common and does not mean
that you should give up
• Your team will work with you to help determine what
the best next step might be
33. What does this new initiative mean for
patients and families?
• No more knocking on the wrong door, if this service
is not a good fit we will help you find the right door
in the SUCD program at the Royal or in a community
program
• Customized treatment based on your addiction and
mental health picture
• Education and support for patients and families
34. What will this mean for the community?
• Further linkages of community agencies
• Formation of links between family doctors and
community addiction and mental health agencies
• Increased capacity of the region to identify and treat
opioid addiction and mental health problems
• Increased access to addiction and mental health care
for opioid users where they live
35. References
• Methadone Maintenance Treatment Program Standards and Clinical
Guidelines, 4th edition February 2011 CPSO
• Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice
Guideline 2011 (CAMH)
• Paglia-Boak, A, Mann, RE, Adlaf, EM (2011). Drug use among
Ontario students,1977-2011: OSDUHS highlights. (CAMH Research
Document Series No. 32). Toronto, ON: Centre for Addiction and
Mental Health.
• NIDA National Institute on Drug Abuse
• Substance Abuse: A Comprehensive Textbook 4th Ed. Lewinson et
al. 2005
36. References
• Principles of Addiction Medicine 4th ed. , American Society of
Addiction Medicine. 2009
• Lowinson & Ruiz’s Substance Abuse: A Comprehensive Textbook
Fifth Edition Chapter 57 Adolescent Substance Abuse R. Milin and S.
Walker. Editors Pedro Ruiz &Eric Strain. Lippincott Williams &
Wilkins, Philadelphia, PA, 2011
• Skinner, H.A. (1982). The Drug Abuse Screening Test. Addictive
Behaviors, 7, 363-371. The DAST-10 was developed and copyrighted
by Dr. Harvey A. Skinner, PhD, Department of Public Health Services
at the University of Toronto, and the Centre for Addiction and
Mental Health, Toronto, Canada.