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Harm Reduction for the Lost Generation.
This document discusses harm reduction strategies for patients at high risk of opioid overdose during the current opioid epidemic. It identifies populations at risk, such as those prescribed methadone, at doses over 120mg of morphine equivalents daily, or those prescribed benzodiazepines or sedatives along with opioids. It recommends prescribing nasal naloxone to these at-risk patients and tapering opioid doses to safer levels. For patients requiring long-term opioid treatment, it suggests switching to buprenorphine which has a ceiling effect reducing risk of overdose. The goal is to reduce harm for the "Lost Generation" of patients dependent on opioids.
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- 1. Harm Reduction forthe Lost Generation Paul C. Coelho, MD Board Certified PM&R Subspecialty Certified Pain Medicine
- 2. Table Of Contents 1.The Opioid Epidemic 2. The Lost Generation 3. Harm Reduction Strategies
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- 12. Guns, MVA’s &ODD’s 2000-2015 http://www.realclearpolicy.com/blog/2015/12/21/guns_vs_cars_and_drugs_1500.html
- 13. Oregon Ranks #1in the Nation in Prescription Opioid Abuse www.orpdmp.com/orpdmpfiles/PDF_Files/Reports/Statewide_10.01.11_to_03.31.12.pdf
- 14. Prescription Opioid Deaths InOregon 2000-2011 http://www.orpdmp.com/orpdmpfiles/PDF_Files/Reports/NGA-overdose-presentation_Millet_12-05-2012.pdf
- 15. Top Oregon Countiesfor Opioid Prescriptions 160.0000 172.5000 185.0000 197.5000 210.0000 Josephine D ouglas Sherm an Lincoln C latsop Linn C rook C urry Jackson Jefferson County http://www.orpdmp.com/orpdmpfiles/PDF_Files/Reports/Statewide_10.01.11_to_03.31.12.pdf
- 16. Prescribed Opioid Addiction TxBy Age http://wwwdasis.samhsa.gov/teds09/TEDS2k9NChp2.htm
- 17. Age of OpioidODD www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
- 18. Risk Factors foran ODD http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
- 19. Dose as aRisk Factor For ODD https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/3.Practice_Management/2.Quality_Improvement/ 2.Patient_Safety/2.Patient_Safety_Education/C171%20-%20Franklin.pdf
- 20. Methadone as aRisk Factor for ODD https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
- 21. Methadone as aRisk Factor for ODD https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
- 22. Benzodiazepines & Opioids asa Risk Factor for ODD https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
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- 25. Pain Vs Fearof Withdrawal? http://www.ncbi.nlm.nih.gov/pubmed/24814051
- 26. Buprenorphine for theLost Generation http://www.ncbi.nlm.nih.gov/pubmed/25220043
- 27. Buprenorphine for theLost Generation http://www.ncbi.nlm.nih.gov/pubmed/23584313
- 28. Buprenorphine Is A PowerfulAnalgesic http://www.compoundchem.com/2014/09/25/painkillers/
- 29. Harm Reduction forthe Lost Generation Identify the population at risk: a. Methadone b. Dose > 120MED c. Coprescribed benzo’s &/or sedatives
- 30. Prescribe Nasal Naloxone 1.SB 384 legalized for lay administration in 2013. 2. Stock in your pharmacies. 3. Some patients must pay out of pocket ($35.00.) 4. http://www.prescribetoprevent.org/ wp-content/uploads/2012/11/ naloxone-one-pager-in- nov-2012.pdf
- 31. Dose MTD <30 or MED < 240 1. Offer an alternative analgesic to MTD: MS04, etc. 2. Offer an opioid taper with an end point below 120MED. 3. Offer a benzodiazepine taper. http://agencymeddirectors.wa.gov/mobile.html
- 32. Dose MTD >30 or MED > 240 Hi Dose Patient Taper Buprenorphine VS
- 33. Buprenorphine 1. Schedule IIIdrug, partial mu agonist 2. FDA approved for both pain - Butrans/Belbuca - and addiction - Suboxone/Subutex. 3. Ceiling effect for respiratory suppression (RS).
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