Heather Davidson and Jim Hall History of Opiates in the U.S. It - - PowerPoint PPT Presentation

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Heather Davidson and Jim Hall History of Opiates in the U.S. It - - PowerPoint PPT Presentation

Sep 09, 2023 151 likes •507 views

Presented by: Heather Davidson and Jim Hall History of Opiates in the U.S. It was from opium that morphine was derived as a pain killer in 1810. Due to the euphoria that it produced it was named after the Greek god of dreams, Morpheus,

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Presented by: Heather Davidson and Jim Hall

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History of Opiates in the U.S.

  • It was from opium that morphine was derived as a pain killer in 1810.
  • Due to the euphoria that it produced it was named after the Greek

god of dreams, Morpheus, by a German physician.

  • Morphine was heavily used to treat pain in soldiers during the Civil

War, leaving many addicted to morphine.

  • In 1874, a new drug, Heroin was created in Germany and sold in the

United States as a “safe, non-addictive” substitute for morphine.

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History of Opiates in the U.S.

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History of Opiates in the U.S.

  • Laudanum was a mixture of opium in an alcohol base and used as we

would use aspirin today.

  • Heroin, morphine and other opiates were sold legally in the U.S. until

1920 with the passing of the Dangerous Drug Act.

  • In 1925, there were an estimated 200,000 heroin addicts in the U.S.
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Cultural Acceptance of Rx Drugs

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  • The rate for drug overdose deaths has increased approximately

140% since 2000, driven largely by opioid overdose deaths.

  • After increasing since the 1990s, deaths involving the most

commonly prescribed opioid pain relievers declined slightly in 2012 and remained steady in 2013, showing some signs of progress.

  • Heroin overdose deaths have been sharply increasing since 2010.
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Drug overdose deaths increased significantly from 2013 to 2014.

  • Increases in opiate overdose deaths were the main factor in the increase in

drug overdose deaths.

  • The death rate from the most commonly prescribed opioid pain relievers

increased 9%.

  • The death rate from heroin increased 26%.
  • The death rate from synthetic opioids, a category that includes illicitly

manufactured fentanyl increased 80%.

  • Florida ranked # 3 in the nation with 2,634 drug overdose deaths in 2014.
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Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida 2008 to 2015

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2008 - Jun 2015 Reports

# “Cause of Death” Occurrences

476 465 533 652 715 801 607 640 392 343 279 255 219 251 274 337 336 380 340 336 358 341 350 274 238 221 168 170 142 158 153 147 160 142 110 152 144 201 176 239 268 300 295 410 387

141 129 136 129 139 176 136 171 118 126 158 133 119 131 108

85 100

139

258 289

100 200 300 400 500 600 700 800 900

Oxycodone Methadone Morphine Hydrocodone Fentanyl

House Bill 7095 Takes effect CS-II Dispensing Limits & OxyContin Tamper Resistant

Strike Force

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208 271 250 230 150 109 78 93 119 95 48 57 108 199 447

686*

100 200 300 400 500 600 700 800

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H 2015

Number of Heroin Deaths in Florida: 2000 to 2015*

# of Heroin Deaths Source: Florida Medical Examiners Commission 2015 Interim Report * Projected Increase based on 2 X 1st Half of 2015

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Number of Deaths Related to Fentanyl or Heroin in Broward County Florida: 2010-2015

3 11 14 21 53 79 5 3 9 11 28 68

10 20 30 40 50 60 70 80 90 2010 2011 2012 2013 2014 2015

Fentanyl Heroin

Sources: 2010-2013 FL Medical Examiner Commission Raw Data Tables , 2014 FL Medical Examiner Annual Report, 2015 Data from Broward Medical Examiner Office

2015 Fentanyl Cases 98 % Cause of Death 91 % w/Other Drugs 2015 Heroin Cases 97 % Cause of Death 85 % w/Other Drugs

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CDC Prescribing Guidelines

1. Consider alternative therapies before prescribing

  • pioids.

2. Establish treatment goals before starting opioid therapy. 3. Check in with patients before and during treatment to discuss potential risks and benefits. 4. Prescribe immediate-release opioids vs. extended-release.

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CDC Prescribing Guidelines

lowest effective dosage acute pain only prescribe a maximum of 3-day supply at the lowest effective dosage prescribing naloxone

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CDC Prescribing Guidelines

9. Clinician should review patient history of substance abuse.

  • 10. Clinicians should use urine drug screen before

starting opioid therapy.

  • 11. Clinicians should avoid prescribing opioids and

benzodiazepines concurrently.

  • 12. Clinicians should offer medication-assisted treatment

for an opioid use disorder.

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Safe Disposal of Rx Drugs

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Overdose Prevention

Call 911

Feels like:

  • No energy or strength
  • Vomiting

Looks like:

  • Slow or no pulse
  • Slow or no breathing
  • Skin is pale and blue, feels cold
  • Body is limp and can’t wake up/talk
  • Pupils are pinned or eyes are rolled

back

  • Vomiting
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Overdose Prevention for Users

  • Do use less. Fentanyl, a powerful opioid, has

been contributing to the increase in overdoses.

  • Do sample small dose before use.
  • Do eat regularly.
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Overdose Prevention for Users

  • Don’t mix drugs and alcohol
  • Don’t use from an unknown source
  • Don’t share needles
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Overdose Prevention: Naloxone

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Overdose Prevention: Naloxone

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Overdose Prevention: The Good Samaritan Act

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Overdose Prevention: Naloxone Training for Families and Paramours

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Overdose Prevention: Post Overdose Reversal

  • First responders should take patient to the

Emergency Department immediately.

  • Refer to treatment
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How Do Address the Treatment Shortage ?

Beds Chairs

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Treatment: Medication-Assisted Treatment

Stabilize brain chemistry Relieve physiological cravings

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Myths: Medication-Assisted Treatment

  • 2. Medications are a crutch that prevents true recovery from addiction.
  • 4. Courts are in as good of a position as a doctor to determine the

appropriate treatment for a person’s addiction.

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Harm Reduction: Syringe Exchange Programs

Dozens of scientific studies conducted over the last 20 years, including from the Center for Disease Control and the National Institute for Health, irrefutably demonstrate that syringe exchange programs (SEPs) can play an important role in reducing HIV and viral hepatitis C infection and advancing public safety, especially for law enforcement

  • fficials. These studies establish that SEPs do not increase

crime or drug use, and provide a gateway to drug treatment and infectious disease prevention.

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Myths: Syringe Exchange Programs

  • 1. Syringe Exchange Programs (SEPs) promote drug abuse.
  • 3. SEPs increase crime
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Strategies from Cities around the U.S

Multnomah County, Oregon:

  • Increased use of the PDMP: More than 99% of

pharmacies are required to report, under mandatory Oregon law.

  • Advocacy for statewide adoption of the CDC prescribing guidelines
  • Syringe Exchange Programs and Naloxone Trainings
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Strategies from Cities around the U.S

Manatee County, Florida:

  • Increased access to treatment
  • Change in Marchman Act Protocol
  • Hospitals to provide safe Rx disposal information at

discharge, including Deterra disposal bags.

  • Education to the community and physicians regarding

Naloxone

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Strategies from Cities around the U.S

Gloucester, Massachusetts:

  • ANGEL Amnesty program at Gloucester Police

Department

  • Rx Prescription Medication Disposal Program
  • Overdose prevention education, referrals and services
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www.drugfreebroward.org www.samhsa.gov

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https://healthygloucestercoalition.wordpress.com/programsevents/ http://gloucesterpd.com/addicts/ https://public.health.oregon.gov/About/Pages/ship-substance-use.aspx http://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/Fact% 20Sheets/PDMP_2015v02262015.pdf http://www.drugfreemanatee.org/ https://store.samhsa.gov/shin/content/SMA09-4443/SMA09-4443.pdf www.drug freebroward.org http://www.cdc.gov/drugoverdose/prescribing/guideline.html https://www.drugabuse.gov/publications/research-reports/prescription- drugs/opioids/what-are-opioids