This document discusses the growing problem of prescription drug abuse and misuse in the United States. It summarizes recent trends showing increasing rates of prescription drug misuse and overdose deaths. It outlines how commonly abused drug classes like opioids and stimulants affect the brain and explains why people abuse these drugs for their rewarding effects. It also describes strategies being developed to increase treatment, such as new medications to treat addiction and reverse overdoses, as well as health applications and interventions to address this important public health issue.
This document summarizes NIH efforts to advance pain relief while curbing opioid abuse. It discusses research on abuse-deterrent drug formulations, easier-to-use naloxone delivery methods, digital interventions to prevent overdose, and vaccine development to treat addiction. Monitoring the Future study results on nonmedical prescription opioid and heroin use among youth are presented. The director highlights collaborative work on an oral oxycodone prodrug and a promising heroin vaccine in development.
This document summarizes opioid prescribing trends, policies, and their impacts in Canada and at the US-Canada border. It finds that while Canada and the US have high opioid consumption, Canadian policies like introducing tamper-deterrent OxyContin and a prescription monitoring program reduced potentially inappropriate prescribing by 1%. However, over 1 million such prescriptions remain, and inconsistencies in provincial policies and lack of prescriber access to prescription data limit the policies. The approval of generic long-acting oxycodone in Canada did not increase trafficking into the US, though losses cannot be tracked. Ongoing evaluation is needed to improve policies around opioid availability and curb misuse across the border.
This document outlines an opioid abuse prevention plan 2.0. It summarizes data showing increasing opioid and heroin overdose deaths between 1999-2013. It discusses efforts to increase prescriber education, expand prescription drug monitoring programs, improve drug disposal, and make naloxone more available. The plan focuses on continued education, monitoring, disposal, enforcement, and expanding treatment and overdose prevention programs like medication-assisted treatment and naloxone access.
This document summarizes research priorities and findings from the National Institute on Drug Abuse (NIDA) regarding the opioid crisis. It outlines NIDA's focus on alternative pain treatments, preventing opioid use disorder and overdoses, improving treatment for opioid use disorder, and implementing evidence-based solutions. Specific areas of research discussed include biomarkers for pain, abuse-deterrent drug formulations, non-medication pain treatments, universal prevention programs for adolescents, easier-to-use naloxone for overdose reversal, new formulations of addiction medications, increasing access to medication-assisted treatment, and using addiction medications earlier to prevent heroin overdoses and improve treatment retention.
This document summarizes a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
This document summarizes NIH efforts to advance pain relief while curbing opioid abuse. It discusses research on abuse-deterrent drug formulations, easier-to-use naloxone delivery methods, digital interventions to prevent overdose, and vaccine development to treat addiction. Monitoring the Future study results on nonmedical prescription opioid and heroin use among youth are presented. The director highlights collaborative work on an oral oxycodone prodrug and a promising heroin vaccine in development.
This document summarizes opioid prescribing trends, policies, and their impacts in Canada and at the US-Canada border. It finds that while Canada and the US have high opioid consumption, Canadian policies like introducing tamper-deterrent OxyContin and a prescription monitoring program reduced potentially inappropriate prescribing by 1%. However, over 1 million such prescriptions remain, and inconsistencies in provincial policies and lack of prescriber access to prescription data limit the policies. The approval of generic long-acting oxycodone in Canada did not increase trafficking into the US, though losses cannot be tracked. Ongoing evaluation is needed to improve policies around opioid availability and curb misuse across the border.
This document outlines an opioid abuse prevention plan 2.0. It summarizes data showing increasing opioid and heroin overdose deaths between 1999-2013. It discusses efforts to increase prescriber education, expand prescription drug monitoring programs, improve drug disposal, and make naloxone more available. The plan focuses on continued education, monitoring, disposal, enforcement, and expanding treatment and overdose prevention programs like medication-assisted treatment and naloxone access.
This document summarizes research priorities and findings from the National Institute on Drug Abuse (NIDA) regarding the opioid crisis. It outlines NIDA's focus on alternative pain treatments, preventing opioid use disorder and overdoses, improving treatment for opioid use disorder, and implementing evidence-based solutions. Specific areas of research discussed include biomarkers for pain, abuse-deterrent drug formulations, non-medication pain treatments, universal prevention programs for adolescents, easier-to-use naloxone for overdose reversal, new formulations of addiction medications, increasing access to medication-assisted treatment, and using addiction medications earlier to prevent heroin overdoses and improve treatment retention.
This document summarizes a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
This document summarizes two presentations on treatment of opioid use disorders given at the National Prescription Drug Abuse Summit in 2014.
The first presentation outlines the risks of current inpatient opioid detoxification methods and benefits of evidence-based alternatives. It also examines opportunities for stakeholders to impact opioid addiction education.
The second presentation discusses innovations in buprenorphine treatment, including collaborative care models, group practice models, and strategies to address high-risk patients prescribed buprenorphine in office-based opioid treatment settings. Buprenorphine prescriber shortages, standards, retention challenges, and predictors of positive outcomes are also reviewed.
This document summarizes a presentation on insights from state policies and interventions to curb prescription drug overdoses. It describes several interventions:
1) PRIMUM, a system in North Carolina that alerts prescribers to patients' risk of misusing or abusing opioids at the point of care.
2) A project in Rhode Island that developed protocols to improve opioid prescription safety for trauma patients, including alerts if prescriptions exceed dosage thresholds and requiring naloxone co-prescriptions.
3) A study in Pennsylvania that used Medicaid claims data to identify risk factors for opioid overdoses, such as high dosage and multiple prescribers/pharmacies, to target high-risk patients.
This document summarizes trends shaping workers' compensation medication policies in 2014. It discusses the influence of various factors, including political influences from the Affordable Care Act and state elections; clinical influences like an aging population and the opioid epidemic; and product influences as new medications enter the market. It also outlines debates around issues like physician dispensing, compounded medications, medical marijuana, and opioid monitoring programs.
Tackling the Opioid Problem - Analgesic Prescribing in the Emergency DepartmentSCGH ED CME
This document discusses the opioid crisis and approaches to pain management. It describes how Purdue Pharma aggressively marketed OxyContin in the 1990s, leading to widespread overprescription and misuse. This contributed significantly to the rise in opioid overdoses and deaths in the US. In response, pharmaceutical companies developed abuse-deterrent formulations of opioids like OxyContin and Targin to discourage tampering and injection. However, these formulations did not prove abuse-proof. The document advocates for careful opioid prescribing practices to limit diversion and abuse, including assessing risks, limiting durations, and involving specialist services. Non-opioid options like paracetamol, NSAIDs, and tramadol should be prioritized for mild-moderate pain
The document discusses factors that can lead to transition from misuse of prescription opioid analgesics to heroin initiation. Through qualitative interviews with 31 individuals in New York City, four key factors were identified: 1) Use of high dose opioid analgesics; 2) Intranasal route of administration; 3) Development of physical opioid dependence; and 4) Dissolution of stigma regarding heroin in social networks. The trajectory toward heroin use was found to be similar regardless of whether opioid analgesic initiation was recreational or medical in nature.
1) Dr. Sergey Motov conducted ED shifts without prescribing any opioids as part of research on opioid-free pain management approaches. His website painfree.com provides education on this topic.
2) Swedish EDs have initiated programs to reduce unnecessary opioid prescriptions given risks of addiction, misuse, and overdose.
3) The document discusses alternatives to opioid analgesics for ED patients, including NSAIDs, gabapentinoids, tramadol, buprenorphine, ketamine, and alpha-2 agonists. It emphasizes multimodal, multireceptor approaches to pain management.
Rx16 federal tues_200_1_gladden_2halpin_3greenOPUNITE
This document provides information about the emerging fentanyl overdose epidemic in the United States from the national and state perspectives. It discusses the rise in fentanyl-related overdoses and seizures from 2013-2014 according to data from various sources. The learning objectives are to explain the epidemiology of the rise in fentanyl overdoses, identify lessons from an Ohio investigation, and describe one state's experience. Recommendations include improving detection of fentanyl through testing and surveillance, expanding naloxone access, and long-term efforts to reduce opioid overdoses through prescribing guidelines and treatment expansion.
This document summarizes a presentation on research related to intrauterine drug exposure and neonatal abstinence syndrome (NAS). It provides background on the presenters and their disclosures. The objectives are then outlined, including defining key terms, outlining short and long-term impacts of drug exposure and NAS, genetic factors associated with NAS outcomes, and standards of care for addiction in pregnancy. Details from the various presentation sections are then provided on topics like opioid prescriptions, NAS rates and costs, maternal complications, and neonatal outcomes of exposed infants.
We honor ourselves when we speak out for recovery. We show the world that recovery matters because it brings hope and peace into the lives of individuals and their loved ones. ~ Beth Wilson
The only person you are destined to become is the person you decide to be. ~ Ralph Waldo Emerson
Success is the sum of small efforts, repeated day in and day out.
~ Robert Collier
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
This document outlines a presentation given by Joseph Rannazzisi, Deputy Assistant Administrator at the DEA Office of Diversion Control. The presentation discusses the pharmacological properties and abuse potential of Zohydro ER, an extended release hydrocodone product, and outlines approaches for law enforcement to reduce abuse and diversion of the drug. It also describes potential methods for abuse and diversion of Zohydro ER. The presentation aims to educate on the opioid epidemic, properties of Zohydro ER, and law enforcement strategies to address abuse and diversion.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
This document summarizes information about prescription drug monitoring programs (PMPs) and their role in preventing prescription drug abuse. Some key points:
- PMPs track prescriptions for controlled substances to identify patterns of abuse and diversion. Most states now have PMPs operating.
- Studies have found that a small percentage of individuals (around 1-2%) exhibit questionable patterns like using many prescribers and pharmacies. Early PMP queries in Kansas identified some individuals receiving high amounts of controlled substances from multiple providers.
- One study found that states with PMPs in place did not see significant reductions in overdose death rates compared to states without PMPs. However, PMP characteristics like mandatory
National Rx Drug Abuse Summit, April 2-4, 2013, General Session presentation "Realities of Addiction," by Dr. Nora Volkow, Director, National Institute on Drug Abuse
ATALANTA 28-31 MARZO 2016 | 1. Rx Drug Abuse and Heroin Where is Science Leading Us? Nora D. Volkow, M.D. Director @NIDAnews National Institute on Drug Abuse
2. Numbers in Millions Prescription Drug Misuse/Abuse is a Major Problem in the US Source: SAMHSA, 2014 National Survey on Drug Use and Health ...
This document summarizes two presentations on treatment of opioid use disorders given at the National Prescription Drug Abuse Summit in 2014.
The first presentation outlines the risks of current inpatient opioid detoxification methods and benefits of evidence-based alternatives. It also examines opportunities for stakeholders to impact opioid addiction education.
The second presentation discusses innovations in buprenorphine treatment, including collaborative care models, group practice models, and strategies to address high-risk patients prescribed buprenorphine in office-based opioid treatment settings. Buprenorphine prescriber shortages, standards, retention challenges, and predictors of positive outcomes are also reviewed.
This document summarizes a presentation on insights from state policies and interventions to curb prescription drug overdoses. It describes several interventions:
1) PRIMUM, a system in North Carolina that alerts prescribers to patients' risk of misusing or abusing opioids at the point of care.
2) A project in Rhode Island that developed protocols to improve opioid prescription safety for trauma patients, including alerts if prescriptions exceed dosage thresholds and requiring naloxone co-prescriptions.
3) A study in Pennsylvania that used Medicaid claims data to identify risk factors for opioid overdoses, such as high dosage and multiple prescribers/pharmacies, to target high-risk patients.
This document summarizes trends shaping workers' compensation medication policies in 2014. It discusses the influence of various factors, including political influences from the Affordable Care Act and state elections; clinical influences like an aging population and the opioid epidemic; and product influences as new medications enter the market. It also outlines debates around issues like physician dispensing, compounded medications, medical marijuana, and opioid monitoring programs.
Tackling the Opioid Problem - Analgesic Prescribing in the Emergency DepartmentSCGH ED CME
This document discusses the opioid crisis and approaches to pain management. It describes how Purdue Pharma aggressively marketed OxyContin in the 1990s, leading to widespread overprescription and misuse. This contributed significantly to the rise in opioid overdoses and deaths in the US. In response, pharmaceutical companies developed abuse-deterrent formulations of opioids like OxyContin and Targin to discourage tampering and injection. However, these formulations did not prove abuse-proof. The document advocates for careful opioid prescribing practices to limit diversion and abuse, including assessing risks, limiting durations, and involving specialist services. Non-opioid options like paracetamol, NSAIDs, and tramadol should be prioritized for mild-moderate pain
The document discusses factors that can lead to transition from misuse of prescription opioid analgesics to heroin initiation. Through qualitative interviews with 31 individuals in New York City, four key factors were identified: 1) Use of high dose opioid analgesics; 2) Intranasal route of administration; 3) Development of physical opioid dependence; and 4) Dissolution of stigma regarding heroin in social networks. The trajectory toward heroin use was found to be similar regardless of whether opioid analgesic initiation was recreational or medical in nature.
1) Dr. Sergey Motov conducted ED shifts without prescribing any opioids as part of research on opioid-free pain management approaches. His website painfree.com provides education on this topic.
2) Swedish EDs have initiated programs to reduce unnecessary opioid prescriptions given risks of addiction, misuse, and overdose.
3) The document discusses alternatives to opioid analgesics for ED patients, including NSAIDs, gabapentinoids, tramadol, buprenorphine, ketamine, and alpha-2 agonists. It emphasizes multimodal, multireceptor approaches to pain management.
Rx16 federal tues_200_1_gladden_2halpin_3greenOPUNITE
This document provides information about the emerging fentanyl overdose epidemic in the United States from the national and state perspectives. It discusses the rise in fentanyl-related overdoses and seizures from 2013-2014 according to data from various sources. The learning objectives are to explain the epidemiology of the rise in fentanyl overdoses, identify lessons from an Ohio investigation, and describe one state's experience. Recommendations include improving detection of fentanyl through testing and surveillance, expanding naloxone access, and long-term efforts to reduce opioid overdoses through prescribing guidelines and treatment expansion.
This document summarizes a presentation on research related to intrauterine drug exposure and neonatal abstinence syndrome (NAS). It provides background on the presenters and their disclosures. The objectives are then outlined, including defining key terms, outlining short and long-term impacts of drug exposure and NAS, genetic factors associated with NAS outcomes, and standards of care for addiction in pregnancy. Details from the various presentation sections are then provided on topics like opioid prescriptions, NAS rates and costs, maternal complications, and neonatal outcomes of exposed infants.
We honor ourselves when we speak out for recovery. We show the world that recovery matters because it brings hope and peace into the lives of individuals and their loved ones. ~ Beth Wilson
The only person you are destined to become is the person you decide to be. ~ Ralph Waldo Emerson
Success is the sum of small efforts, repeated day in and day out.
~ Robert Collier
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
This document outlines a presentation given by Joseph Rannazzisi, Deputy Assistant Administrator at the DEA Office of Diversion Control. The presentation discusses the pharmacological properties and abuse potential of Zohydro ER, an extended release hydrocodone product, and outlines approaches for law enforcement to reduce abuse and diversion of the drug. It also describes potential methods for abuse and diversion of Zohydro ER. The presentation aims to educate on the opioid epidemic, properties of Zohydro ER, and law enforcement strategies to address abuse and diversion.
Rx16 federal tues_330_1_spitznas_2baldwin_3welchOPUNITE
This document discusses patient review and restriction programs (PRRs) as tools to help curb prescription drug abuse and coordinate patient care. It describes state Medicaid PRR programs and recent efforts to expand PRR programs to Medicare. It also describes the role of PRR programs in the CDC's Prescription Drug Overdose Prevention for States grant program, the Office of National Drug Control Policy's national strategy, and the federal budget.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
This document summarizes information about prescription drug monitoring programs (PMPs) and their role in preventing prescription drug abuse. Some key points:
- PMPs track prescriptions for controlled substances to identify patterns of abuse and diversion. Most states now have PMPs operating.
- Studies have found that a small percentage of individuals (around 1-2%) exhibit questionable patterns like using many prescribers and pharmacies. Early PMP queries in Kansas identified some individuals receiving high amounts of controlled substances from multiple providers.
- One study found that states with PMPs in place did not see significant reductions in overdose death rates compared to states without PMPs. However, PMP characteristics like mandatory
National Rx Drug Abuse Summit, April 2-4, 2013, General Session presentation "Realities of Addiction," by Dr. Nora Volkow, Director, National Institute on Drug Abuse
ATALANTA 28-31 MARZO 2016 | 1. Rx Drug Abuse and Heroin Where is Science Leading Us? Nora D. Volkow, M.D. Director @NIDAnews National Institute on Drug Abuse
2. Numbers in Millions Prescription Drug Misuse/Abuse is a Major Problem in the US Source: SAMHSA, 2014 National Survey on Drug Use and Health ...
The document discusses the opioid crisis in the United States, including rising rates of prescription opioid misuse and abuse, as well as heroin use and overdose deaths. It outlines how research can help address this crisis through developing less abusable analgesics, expanding access to treatment medications like naloxone and buprenorphine, and exploring new treatment approaches such as immunotherapies and precision medicine targeting genetic factors. The National Institute on Drug Abuse is supporting these research efforts and working to disseminate findings to improve prevention and intervention programs.
This document discusses the relationship between drug abuse and HIV/AIDS. It provides statistics showing that injection drug use remains a major mode of HIV transmission worldwide. The document also notes that drug abuse treatment is the most effective HIV prevention strategy for injection drug users, but that there are challenges in implementing treatment programs. Future research focuses on long-acting medications and immunotherapies to help treat addiction.
MedTech Healthcare Group is the largest provider of outpatient substance abuse treatment programs in Westmoreland and Indiana counties in Pennsylvania, operating three clinics over the past decade. It has treated thousands of patients for opioid addiction and helped reduce the impact of the opioid epidemic. MedTech is on track to generate $3 million in revenue and $900,000-1 million in EBITDA in 2015, with steady growth since its founding in 2006. The behavioral healthcare industry, particularly medication-assisted treatment (MAT) for opioid addiction, represents a large and growing market opportunity.
This document discusses a presentation on expanding the use of naloxone. The presentation includes three speakers who will discuss (1) naloxone collaborative practice agreements with pharmacies, (2) a model for using intranasal naloxone as a universal precaution for patients on chronic opioid therapy, and (3) whether co-prescribing intranasal naloxone impacts overdose deaths. The document provides background on the speakers and moderators, as well as learning objectives and an agenda for the presentation.
This document summarizes research on drug addiction and its effects on the brain. It finds that addiction is a chronic brain disease characterized by compulsive drug seeking and use despite negative consequences. Addiction involves changes in brain structure and function that can last a lifetime if left untreated. Research shows that drug use changes the brain in fundamental ways by disrupting the brain's reward system and other neurotransmitter systems like dopamine and serotonin. Prevention and treatment strategies must address addiction's biological and behavioral aspects.
The document discusses the growing problem of prescription drug abuse and overdose deaths in the United States. Some key points made include:
- In 2010, there were over 38,000 drug overdose deaths in the US, with prescription drugs accounting for over 22,000 of those deaths.
- Prescription drug abuse is the fastest growing drug problem in the country.
- Deaths from drug overdoses now outnumber deaths from motor vehicle accidents.
- The number of forensic drug cases tested has increased over 240% from 2001 to 2011.
- States in the Southwest and Appalachia have the highest rates of drug overdose mortality.
Non-Alcoholic, Drug-Related Deaths in St Croix County WI from 2010 to 2015-An...Warren Taylor
This study analyzed drug-related death data from 2010-2015 in St. Croix County, WI. The author found that while total deaths remained stable, non-alcoholic drug deaths increased from 1 in 2010 to 9 in 2015. Mixed drug overdoses were the most common, often involving opioids and other medications. Males and those aged 20-50 experienced the majority of deaths. The findings were consistent with national data showing an opioid epidemic. The author recommends prevention strategies used successfully elsewhere, such as prescription drug monitoring programs and education.
This document provides an overview of a presentation given at the Virginia Rural Health Association Annual Conference on December 11, 2014 about the REVIVE! project in Virginia. The presentation discusses the high rates of opioid overdose deaths in the US and Virginia, describes how naloxone works to reverse opioid overdoses, and outlines the development and implementation of the REVIVE! pilot programs which trained laypeople to administer intranasal naloxone to reverse overdoses.
Interesting things about alcohol and other drugs - Nov 2016Andrew Brown
One in a regular series of slide sets on interesting data about alcohol and other drugs (and the wider issues to do with multiple needs) from a UK perspective.
Prescription drug abuse, especially of opioids, is a major problem in the United States, with millions of Americans misusing controlled prescription drugs each year. The misuse of pharmaceuticals has increased significantly while the abuse of illicit drugs has remained steady. While prescription drugs serve important medical purposes, widespread non-medical use has led to a rise in emergency room visits, overdose deaths, and admissions for treatment of prescription drug abuse. Coordinated efforts are needed across healthcare, law enforcement, and community levels to address this epidemic.
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
- Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
This document outlines efforts by several states to leverage prescription drug monitoring program (PDMP) data as public health surveillance tools through CDC's Prevention Boost grant program. It describes Oklahoma's program which expanded PDMP data sharing and used the data for epidemiological analyses to monitor trends in high-risk prescribing behaviors and health outcomes. It also discusses Utah's program which evaluated causes of prescription opioid deaths using PDMP data and supported several pieces of legislation. Finally, it summarizes Kentucky's program which addressed the state's high prescription drug overdose rates by enhancing its PDMP and linking the data to other health databases for surveillance purposes.
12Week IV, Discussion Post Care for the Client with a Substlauvicuna8dw
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
12Week IV, Discussion Post Care for the Client with a Substdrennanmicah
1
2
Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
1) Prescription drug abuse in the U.S. has reached epidemic levels, with overdose deaths, opioid sales, and treatment admissions all rising in parallel since 1999. 2) To reverse the epidemic, efforts are needed to improve prescription drug monitoring programs (PDMPs), ensure safer opioid prescribing practices, expand access to treatment including buprenorphine, and support state-level prevention strategies. 3) Early evidence suggests that real-time, universal PDMPs; mandating their use; integrating them into electronic health records; and comprehensive laws can all help to reduce doctor shopping, opioid prescribing, and overdose deaths.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
Web rx16 prev_tues_330_1_lawal_2warren_3huddleston_4pershingOPUNITE
This document discusses the role of health departments in preventing neonatal abstinence syndrome (NAS). It notes that NAS rates have increased significantly in recent years, disproportionately affecting women. Health departments engage in surveillance to monitor NAS trends, partner with other organizations, support treatment and recovery programs, and provide education to prevent NAS, which is entirely preventable. The document outlines specific strategies health departments use across these areas to address the opioid epidemic and protect maternal and infant health.
This document summarizes the opioid crisis in the United States from 2000 to 2014. It shows that the number of opioid-related overdose deaths more than tripled during this period, increasing from about 8,000 to over 28,000. Additionally, 7.9 million Americans aged 12 or older met the criteria for an illicit drug use disorder in 2013-2014 but only 20% received treatment. The document outlines actions by the Obama administration to address the crisis and increase funding for treatment. It emphasizes that stories can help reduce stigma and that recovery is possible through working together.
Web rx16 prev_tues_200_1_bretthaude-mueller_2scott_3debenedittis_4cairnes copyOPUNITE
This presentation covered multi-media prevention strategies for issues like prescription drug overdoses. It discussed the CDC's digital Rx drug prevention campaign, best practices for digital messaging, and programs using expectancy challenge theory and media literacy education in schools. Presenters included representatives from the CDC, Media Literacy for Prevention, and the Hanley Center Foundation who discussed their work developing and implementing digital communications and single-session prevention programs.
This document discusses strategies for reducing buprenorphine diversion and pill mills while improving access to treatment. It notes that limiting access to buprenorphine treatment is associated with increased diversion, while expanded access to quality treatment decreases diversion and overdose deaths. The document recommends educating prescribers, using medically-derived prescribing standards, ensuring adequate insurance coverage of safe prescribing practices, and addressing diversion risks for other controlled medications. It argues against onerous new regulations that could limit treatment access. The goal is to identify and support high-quality treatment while prosecuting criminal operations.
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
Rx16 prev wed_330_workplace issues and strategiesOPUNITE
This document discusses workplace issues related to prescription drug abuse and strategies for prevention. It begins with introductions of the presenters and moderators. The learning objectives are then outlined as understanding challenges of prescription drug abuse in the workplace, identifying prevention strategies, and describing programs available through SAMHSA. The document then covers topics such as the scope of prescription drug misuse among workers, risks to the workplace, prevention strategies employers can consider, and available resources from SAMHSA.
Web only rx16 pharma-wed_330_1_shelley_2atwood-harlessOPUNITE
This document discusses a presentation on pharmacy burglary, robbery, and diversion of prescription drugs. The presentation covers trends in prescription drug diversion, particularly those involving robbery and burglary of pharmacies. It identifies preventative measures to enhance pharmacy security and safety. Strategies to reduce pharmacy crimes are outlined. The offender perspective is examined based on interviews with convicted offenders. Routine activities theory is discussed as relating to suitable targets, capable guardians, and motivated offenders. Partnerships between regulatory agencies and law enforcement are emphasized as key to prevention efforts.
Linking and mapping PDMP data can provide several benefits but also faces challenges. Linking PDMP and clinical data allows for evaluating the impact of PDMP interventions on outcomes and prescribing decisions. However, obtaining permissions and data is difficult due to legal and resource barriers. Mapping PDMP data using GIS tools in Washington identified areas for targeting overdose prevention efforts by visualizing patterns in prescribing risks, treatment availability, and overdoses. Stakeholders used these maps to guide education and funding decisions. Sustaining these tools requires ongoing funding and expanding included data sources.
This document discusses drug court models and the role of law enforcement in drug courts. It begins with introductions from presenters and outlines learning objectives about explaining drug court operations and benefits, how law enforcement can utilize drug courts, and identifying best practices. The following sections provide details on drug court models, including how they integrate treatment into the justice system using a non-adversarial approach. Key components of drug courts are outlined, and presenters discuss issues like prescription drug and heroin abuse as well as outcomes from drug courts in reducing recidivism and saving money. Law enforcement can play roles in prevention, addressing domestic violence, and targeting the right populations for drug court involvement through assessment.
This document summarizes presentations from two communities - Huntington, WV and Camden County, NJ - on their responses to heroin crises. It outlines programs implemented in Huntington, including a harm reduction program, centralized information system, and drug court expansion. It also discusses the region's history with prescription drug abuse and rise in heroin and associated issues like hepatitis and neonatal abstinence syndrome. Long-term strategies proposed include expanding treatment services, promoting career opportunities for those in recovery, and preventing relapse through environmental design changes.
This document discusses neonatal abstinence syndrome (NAS) and universal maternal drug testing. It provides background information on NAS including trends showing large increases in incidence and costs associated with NAS. It outlines objectives related to describing NAS trends, identifying legislative activities impacting NAS, describing family planning for women in substance abuse treatment, and explaining a hospital program using universal drug testing. The document then covers topics including NAS symptoms, incidence and geographic trends, costs of NAS, opioid use in women of childbearing age, unintended pregnancy rates, contraceptive use among opioid users, and maternal drug exposure sources.
Web only rx16-adv_tues_330_1_elliott_2brunson_3willis_4deanOPUNITE
This document outlines an advocacy track presentation on activating communities to address prescription drug abuse. It provides biographies of the presenters and moderators and discloses any conflicts of interest. The learning objectives are to identify best practices for implementing CADCA's seven strategies for community change to impact prescription drug issues. It then provides examples of how various coalitions across the country are utilizing each of the seven strategies, such as providing education, enhancing skills, supporting communities, and changing policies.
This document discusses recovery ready ecosystems and recovery community organizations. It introduces presenters from Young People in Recovery and Hope House Treatment Track who will discuss interventions, prevention, and recovery programs. Examples of Young People in Recovery chapters, programs, and services are provided, including employment workshops, education workshops, housing workshops, and recovery support services. The document also discusses recovery community organizations and initiatives in Texas and Georgia, such as the Association of Persons Affected by Addiction in Dallas and the Georgia Council on Substance Abuse.
This document summarizes a presentation on health plan involvement in safe prescribing. It includes:
1) Presentations from medical experts on prescription drug abuse trends from medical examiner data and a tribal health system's safe prescribing program.
2) A discussion of health plan policies to reduce "red flag" medication combinations like opioids plus benzodiazepines through prior authorization, formulary changes, and provider restrictions.
3) Examples of one health plan's implementation of policies like restricting methadone prescriptions to pain specialists and removing carisoprodol from its formulary.
This document summarizes a presentation on youth performance-enhancing drugs and ADHD medication. It discusses trends in misuse of these substances among young people. The presentation is given by representatives from various organizations focused on prevention, health promotion, and substance abuse issues among youth and college students. The presentation covers types of performance-enhancing drugs and their potential side effects. It also discusses trends in attitudes towards these substances and risks of misuse. Strategies are presented for helping adolescents pursue their goals without these drugs. The document concludes by outlining plans for addressing misuse of ADHD medication among college students through education and collaboration between various stakeholder groups.
Web only rx16 pharma wed_200_1_hagemeier_2fleming_3vernachioOPUNITE
Community pharmacists are well positioned to help address the growing problem of opioid and benzodiazepine addiction but face challenges. Early identification of at-risk patients, supportive benefit structures, and intervention training could empower pharmacists. While many recognize their responsibility, behavioral engagement in prevention is often lacking due to practice barriers, lack of patient information, and fear of responses. Standardizing communication expectations and screening tools could help pharmacists better fulfill their role on the treatment team.
1. Two states, South Carolina and Wisconsin, improved integration of PDMP data into electronic health systems by establishing connections between their PDMPs and various health IT platforms like EMR systems and pharmacy dispensing software.
2. States face challenges with PDMP integration like legal definitions of access, costs of integration projects, and establishing necessary agreements and user authorizations.
3. Florida operates drug surveillance systems through a medical examiners commission and PDMP. Analysis found declines in prescription opioid overdoses after implementation of legislative and regulatory interventions including a PDMP in 2011. However, heroin overdose deaths increased as some shifted to heroin.
Web only rx16 len wed_200_1_augustine_2napier_3darr - copyOPUNITE
This document summarizes a presentation about the Handle with Care program, which aims to help children who have been exposed to trauma. The presentation discusses how drug abuse and violence impact children, showing statistics on drug seizures and crimes in certain areas. It then describes the Handle with Care program, where law enforcement notifies schools of children who were exposed to a traumatic event so the school can provide trauma-informed support. School interventions discussed include therapy dogs, academic accommodations, and on-site therapy. The presenters emphasize that Handle with Care aims to help children succeed in school by providing trauma-sensitive support.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
2. Nora Volkow has no financial relationships
with proprietary entities that produce
health care goods and services.
3. 1. Investigate recent increasing trends in the
misuse and abuse of Rx drugs.
2. Demonstrate the ways in which the most commonly
abused Rx drug classes affect the brain and body.
3. Outline strategies being developed and implemented
that will increase awareness of the growing problem.
Learning Objectives
4. Numbers in Millions
Prescription Drug Misuse/Abuse is a
Major Problem in the US
Source: SAMHSA, 2012 National Survey on Drug Use and Health, 2013.
4.7
4.9
5.1 5
4.8 4.9 4.8
4.3
4.8
2.1 2.2 2.1 2.1 2
2.2 2.2
2
2.3
1.2 1.1
1.4
1.2 1.1 1.2 1.1 1
1.3
0.3 0.3 0.4 0.3 0.2 0.3 0.4
0.2 0.2
0
1
2
3
4
5
6
2004200520062007200820092010 2011 2012
Current Drug Use Rates in
Persons Ages 12+
Percent
Past Year Nonmedical Use of Types
of Psychotherapeutic Drugs among
Persons Aged 12 or Older: 2002-2012
5. 0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
Time After Amphetamine
%ofBasalRelease
AMPHETAMINE
0
50
100
150
200
0 60 120 180
Time (min)
%ofBasalRelease
Empty
Box Feeding
Di Chiara et al.
FOOD
VTA/SN
nucleus
accumbens
frontal
cortex
These prescription drugs, like other
drugs of abuse (cocaine, heroin,
marijuana) raise brain
dopamine levels
Dopamine
Neurotransmission
Why Do People Abuse Prescription Drugs?
Di Chiara et al.
6. Opioids: Examples: OxyContin, Vicodin
Attach to opioid receptors in the
brain and spinal cord, blocking the
transmission of pain messages and
causing an increase in the activity
of dopamine
How They Work…
• Postsurgical pain relief
• Management of acute or chronic pain
• Relief of coughs and diarrhea
Opioids are Generally Prescribed for:
Amydala
(reward)
NAc
(reward)
Thalamus
(pain)
7. • Expectation of Drug Effects
Expectation of clinical benefits vs euphoria high
• Context of Administration
School, clinic, home vs bar, discotheque
• Dose and Frequency of Dosing
Lower, fixed regimes vs higher, escalating use
• Route of Administration
Oral vs injection, smoking, snorting
What is the Difference Between
Therapeutic Use and Abuse?
8. Rewarding Effects of Drugs Depend on
How Fast they Get into the Brain
Reward
Reward
0
20
40
60
80
100
0
20
40
60
80
100
0 10 20 30 40 50 60 70 80
%Peak
[11C]Cocaine in brain
Time (min)
[11C]Ritalin in brain
0 10 20 30 40 50 60 70 80
0
0.01
0.02
0.03
0.04
0.05
0.06
0 20 40 60 80 100 120
Time (minutes)
0
0.01
0.02
0.03
0.04
0.05
0.06
UptakeinStriatum(%/cc)
0
0.0005
0.001
0.0015
0.002
0.0025
0.003
0.0035
0 20 40 60 80 100 120
UptakeinStriatum(nCi/cc)
Time (minutes)
iv cocaine iv Ritalin oral Ritalin
0 20 40 60 80 100 120
Time (minutes)
Fast!!"Fast!!" Slow!!"
Cocaine (iv) and
Ritalin (iv) are
rewarding but
Ritalin (oral) is
not.
The slow brain
uptake of oral
Ritalin allows
treatment without
reward
Solanto MV. Behav Brain Res
1998; 94:127–152.
Fowler JS et al., Nuc Med Bio
2001; 28(5): 561-572.
Volkow ND and Swanson JM. Am J Psychiatry 2003;160: 1909-1918.
9. Source: SAMHSA Treatment Episode Data Set
(TEDS), 2000-2010
28,326
37,649
45,882
52,664
60,824
71,048
82,359
98,386
122,185
142,124
157,171
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
12
10
8
6
4
2
0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
*Deaths
are
those
for
which
poisoning
by
drugs
(illicit,
prescrip9on,
and
over-‐the-‐counter)
was
the
underlying
cause.
National Vital Statistics System.
Drug Overdose Death Rates by State 2008.
100 people die from drug
overdoses every day in the US
CDC Vital Signs, July 2013.
10. Primary Substance of Abuse
(Other Than Alcohol**) at Admission
to U.S. State Licensed or Certified
Substance Abuse Treatment Facilities,
Ages 12 and Older
Adapted by CESAR from OAS, SAMHSA,
Treatment Episode Dataset (TEDS) Highlights—2011,
National Admissions to Substance Abuse Treatment Services, 2013.
PercentageofAllAdmissions
20
16
12
8
4
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
Prevalence Of Narcotics
Involvement In Drivers Who
Died Within 1 Hour Of A Crash
Fatality Analysis Reporting System,
Selected States, 1999–2010
Brady JE and Li G
Am. J. Epidemiol. 2014.
PositiveforNarcotics,%
12
10
8
6
4
2
0
1.8%
5.4%
P<0.0001
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
1999
11. Past
Month
&Past
Year
Heroin
Use
Among
Persons
Aged
12
or
Older:
2002-‐2012
Source:
SAMHSA,
2012
Na2onal
Survey
on
Drug
Use
and
Health,
2013.
404
314
398
379
560
373
455
582
621
620
669
166
119
166
136
339
161
213
193
239
281
335
0
100
200
300
400
500
600
700
800
Numbers
in
Thousands
Past
Year
Past
Month
HepaHHs
C
Virus
Among
Adolescents
&Young
Adults
Has
Increased
in
Recent
Years
Incidence
of
acute
hepaHHs
C
by
age
group
–
U.S.,
2000-‐2011
0
0.5
1
1.5
2
2.5
3
Reportedcases/100,000population
0–19 yrs
20–29 yrs
30–39 yrs
40–49 yrs
50–59 yrs
≥60 yrs
Source: National Notifiable Diseases
Surveillance System (NNDSS), CDC
YEAR
12. Opioid Prescriptions
Dispensed by U.S. Retail
Pharmacies, 1991-2012
0
1
2
3
4
5
6
7
8
199920002001200220032004200520062007200820092010
Rate
Year
Opioid Sales KG/10,000
Opioid Deaths/100,000
Opioid Treatment Admissions/10,000
CDC National Vital Statistics System,
SAMHSA Treatment Episode Data Set,
DEA’s Automation of Reports and
Consolidated Orders System.)
Opioid sales increases in US
parallel increases in
opioid OD & Tx admission
IMS Health, Vector One: National , Years 1991 to 2011,
Data Extracted 2012
IMS Health, National Prescription Audit,
Years 2012 & 2013, Data Extracted 2014
13. Source of Prescription
Narcotics Among Those who
Used in the Past Year, 12th Grade*
0
20
40
60
80
100
*Categories not mutually exclusive
SOURCE: University of Michigan,
2013 Monitoring the Future Study
Internet Other
Took
from
friend/
relative
Bought
from
dealer/
stranger
Given
by
friend/
relative
Rx Bought
from
friend/
relative
Source of Prescription Drugs Among
Past Year Users Aged 12 or Older
(how they obtained the drugs they most recently
used nonmedically)
Source: 2012 National Survey on
Drug Use and Health, SAMHSA 2013.
2011 to 2012
14. Opioid Prescriptions by Age
2
6
19
30
159
-
20
40
60
80
100
120
140
160
180
-
5
10
15
20
25
30
35
2002 2006 2009 2012
No.ofPrescriptions,Age40+(millions)
No.ofPrescriptions(millions)
0 to 9 10 to 19 20 to 29 30 to 39 40+
IMS Health, Vector One® National
Opioids Overdose Death
by Age Group, US, 2008
Rateper100,000
Paulozzi LJ, J Safety Res 2012;
43(4): 283-289.
15. Jones, CM et al. JAMA, February 20, 2013; 309(7): 657-659.
PERCENT
Drug Involvement in Pharmaceutical Overdose Deaths
Opioid Analgesic Involvement in Deaths for Specific Drugs
Specific Drug Involvement in
Pharmaceutical Overdose Deaths USA, 2010
75.2
7.8
29.4
1.3
17.6
6.1
0.1
100
65.5
77.2
50
57.6 58
54.2
0
20
40
60
80
100
120
Opioid Analgesics Antiepileptic &
Antiparkinsonism
Drugs
Benzodiazepines Barbiturates Antidepressants Antipsychotic &
Neuroleptic Drugs
Other
Psychotropic
Drugs
16. Medications for Opioid Addiction
effect
no effect
agonist
antagonist
an agonist drug has an
active site of similar shape
to the endogenous ligand
so binds to the receptor
and produces the same effect
an antagonist drug is close
enough in shape to bind to the
receptor but not close enough
to produce an effect. It also
takes up receptor space and so
prevents the endogenous
ligand from binding
OpioidEffect
Full Agonist
(Methadone)
Partial Agonist
(Buprenorphine)
Antagonist
(Naloxone)
Log Dose
Source: SAMHSA, 2012 National Survey on Drug Use and Health, 2013.
17. Opioid Agonist Treatments Decreased
Heroin Overdose Deaths
Baltimore, Maryland, 1995-2009
Schwartz RP et al., Am J Public Health 2013;1 03: 917-922.
OverdoseDeaths,No.
PatientsTreated,No.
Heroin overdoses
Buprenorphine patients
Methadone patients
18. Retention In Methadone
Maintenance Drug Tx
NS after adjusting for demographics,
treatment agencies, other drug use,
public assistance type, medical,
psychiatric, social, legal
and familial factors.
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
PTOP Heroin
Treatment for Addiction to Opioid Medications
Prescription Opioid Abusers can be treated
at MMT facilities at least as effectively as
heroin users in terms of treatment retention.
ODDSRATIO
6.6
49.2
8.6
0
10
20
30
40
50
60
Phase 1 Phase 2 After Taper
%ofPatientsWithSuccessfulOutcomes
Brief and Extended
Buprenorphine-Naloxone Tx
for Rx Opioid Dependence
(Brief) (Extended)
Weiss RD et al., Arch Gen Psych 2011;
68(12): 1238-1246.
Banta-Green CJ et al., Addiction 2009;
104(5): 775-783.
19. Additional Challenge…
Lack of uptake of medication-assisted treatment
Addiction Specialty
Programs Offering
Services
As % of all
programs
surveyed
(N=345)
Within adopting
programs, % of
eligible patients
receiving Rx
Opioid Tx Meds:
Methadone 7.8 41.3
Buprenorphine 20.9 37.3
Tablet naltrexone 22.0 10.9
TOO FEW ARE TREATED
Knudsen et al, 2011, J Addict Med; 5:21-27.
20. How Can Research Help?
• Medications
PAIN: Develop less abusable analgesics
OD: User Friendly Naloxone
ADDICTION: New Medications
• mHealth Applications
• Non pharmacological interventions
22. Naloxone Nasal Spray
OD: User Friendly Naloxone
• AntiOp, single-dose,disposable naloxone nasal
spray that combines a nasal spray device with a
stable, concentrated naloxone solution
• Investigational New Drug (IND) filed in 2012
• Product could be on the market in about 18 months
• Lightlake Therapeutics, biopharmaceutical
company conducting clinical trials with intranasal
naloxone for binge eating disorder is applying it
towards the treatment of opioid overdose
• Clinical trials began last fall
23. mHealth for Preventing OD
Wireless SENSORS
Respiration
Oxymeter
Arrythmias
ALARM
Set up delivery
Alert Patient
Alert Third Party
NALOXONE
DELIVERY
Automatic
Patient
Third party
26. Technologies For Invasive & Non-invasive Neuromodulation
Transcranial Direct
Current Simulation (tDCS)
passes direct current though
two electrodes on the scalp
High-Definition transcranial
Direct Current Stimulation (HD-tDCS)
uses arrays of scalp electrode to
guide current to brain structures
Adapted from: Morena-Duarte I et al., Neuroimage 2014; 85(3): 1003-1013.
Non-Medication Strategies
For the Treatment of PAIN and ADDICTION
Motor Cortex Stimulation
uses electrodes
positioned on the cortex
Left sensory thalamusLeft periventricular gray
Gray AM et al., J Pain
2014; 15(3): 283-292.
Deep Brain Stimulation (DBS)
Stereotaxtic implantation of
electrodes that emit
electrical stimulation
to a targeted
neuronal region
Transcranial Magnetic
Stimulation (TMS)
uses magnets to non-invasively
induce current in the brain
27. • Responsible Prescribing and Management
of Chronic Pain
• Mandatory Addiction Education in Medical,
Nursing and Pharmacy Schools
• Availability of Naloxone
• Parity Tracking and Implementation
• Websites on Location and Quality of
Addiction Treatment Programs
Strategies that can Help Address the Dangers
of Opioid Overdose and Addiction in the US
28. Mezei, L and Murinson, BB., J Pain, 12, 1199 -1208, 2011.
Education on Pain in Medical Schools
Number of Hours of Pain Education
NumberofSchools
USA (median: 7 hours)
Canada (median: 14 hours)
Veterinarian schools:
75 hours on pain
0-5 5-10 10-15 15-20 20-25 25-30 >30
29. • Centers of Excellence in Pain Education (12 CoEPE)
• Consensus Workshop on
Opioids for Chronic Pain
ICs Involved:
ORWH NIA
OBSSR NINR
NIDA NICHD
NIDCR NIAMS
NINDS NCCAM
30. Education for Healthcare Providers
CME Courses developed by NIDA & Medscape Education, funded by ONDCP
Safe Prescribing for Pain
Managing Pain Patients
Who Abuse Rx Drugs
Skills and tools clinicians can use
to screen for and prevent abuse in
patients with pain
Learn symptoms of opioid addiction &
dependence in patients with chronic
pain, & how to screen for, prevent,
& treat such conditions
31. • Responsible Prescribing and Management
of Chronic Pain
• Mandatory Addiction Education in Medical,
Nursing and Pharmacy Schools
• Availability of Naloxone
• Parity Tracking and Implementation
• Websites on Location and Quality of
Addiction Treatment Programs
Strategies that can Help Address the Dangers
of Opioid Overdose and Addiction in the US
32. • NIDA CoEs were established in 2007
to help fill gaps in current medical
education curricula related to both
illicit drugs and Rx drug abuse
• Working with NIDA, medical school
faculty at the CoEs have developed
a diverse portfolio of innovative
curriculum resources about how to
identify and treat patients struggling
with drug abuse and addiction
NIDA
Resources for Medical Students,
Resident Physicians & Faculty
Centers of Excellence
for
Physician Information
33. Percent of Students
Reporting Nonmedical Use
of Vicodin in Past Year
0
5
10
15
20
02 03 04 05 06 07 08 09 10 11 12 13
Denotes significant difference between 2012 and 2013
SOURCE: University of Michigan, 2013 Monitoring the Future Study
0
5
10
15
20
02 03 04 05 06 07 08 09 10 11 12 13
Percent of Students
Reporting Nonmedical Use
of OxyContin in Past Year
8th Grade 10th Grade 12th Grade
PREVENTION WORKS
34.
35. Increases in Heroin Abuse as Access to
Prescription Pain Relievers is Decreased
Cicero TJ et al. N Engl J Med 2012;367:187-189.
Growing evidence suggests that abusers of prescription
opioids are shifting to heroin as prescription drugs become
less available or harder to abuse
For example, a
recent increase in
heroin use accompanied
a downward trend in
OxyContin abuse
following the introduction
of an abuse-deterrent
formulation
of that medication.
Cicero T et al., NEJM 2013.
36. Bateman BT et al, Anesthesiology, February 2014.
Prevalence of Opioid Dispensing
During Pregnancy by State
Opioid Use During
Pregnancy (%)
6.5 -- 11.0
11.1 -- 14.0
14.1 -- 16.5
16.6 -- 20.5
20.6 -- 26.3
(Overall) and By Trimester
ProportionofPregnancies
16
14
12
10
8
6
4
2
0
2005 2006 2007 2008 2009 2010 2011
Anytime in Pregnancy
First Trimester
Second Trimester
Third Trimester
Temporal Trends in
Opioid Dispensing
During Pregnancy
37. Ling, W. et al. JAMA 2010;304:1576-1583.
IMPLANTABLE
Buprenorphine – Probuphine™
Retention of Patients Through the Trial
Delivers
Buprenorphine for 6
Months
120
100
80
60
40
20
0
NumberofPatients
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Week
Buprenorphine
Placebo
66%
31%
Titan Pharmaceuticals
New Medications For Addictions To
Opioid Prescriptions
38. ##p<0.01, ###p<0.001, significant reduction of analgesia
vs. Control/KLH group, ### p<0.001, significant
reduction of analgesia vs. Control/KLH group
Heroin
1
mg/kg,
s.c.
30
min
Hot Plate Test
The Vaccine(s)
New Heroin Vaccine(s)
K.D. Janda & G.F. Koob Laboratories at TSRI
39. FDA NEWS RELEASE -- For Immediate Release: Sept. 10, 2013
The U.S. Food and Drug Administration today announced class-wide safety labeling changes
and new postmarket study requirements for all extended-release and long-acting (ER/LA)
opioid analgesics intended to treat pain.
Safety Labeling Changes & New Postmarket Study
Requirements For All Extended-Release &
Long-acting (ER/LA) Opioid Analgesics
• The class-wide labeling changes include important new language to
help health care professionals tailor their prescribing decisions based
on a patient’s individual needs
• Based on a review of relevant literature, FDA has concluded that more
data are needed regarding the serious risks of misuse, abuse,
hyperalgesia, addiction, overdose, and death associated with the
long-term use of ER/LA opioid analgesics and is thus requiring
ER/LA opioid analgesic drug sponsors to conduct
post-marketing studies and a clinical trial to assess these risks.
40. Prediction of Pain on the Basis of Data from Other Participants in Study 1.
Wager TD et al. N Engl J Med 2013;368:1388-1397.
Pain Signature Map, voxels in which activity reliably predicted pain
fMRI-Based Neurologic Signature of Physical Pain