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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, 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.
History of Opiates in the U.S.
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.
Cultural Acceptance of Rx Drugs
• The rate for drug overdose deaths has increased approximately140% since 2000, driven largely by opioid overdose deaths.
• After increasing since the 1990s, deaths involving the mostcommonly prescribed opioid pain relievers declined slightly in2012 and remained steady in 2013, showing some signs ofprogress.
• Heroin overdose deaths have been sharply increasing since 2010.
Drug overdose deaths increased significantly from 2013 to 2014.
• Increases in opiate overdose deaths were the main factor in the increase indrug 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.
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
# “C
ause
of
De
ath
” O
ccu
rre
nce
s
476 465
533
652715
801
607640
392
343279
255 219 251 274
337 336380
340 336358
341
350274
238 221168 170 142 158153 147 160 142
110152
144201 176
239 268
300 295
410387
141 129 136 129
139 176
136171
118 126158
133
119 131 10885 100
139
258289
0
100
200
300
400
500
600
700
800
900
Oxycodone
Methadone
Morphine
Hydrocodone
Fentanyl
House Bill 7095Takes effect
CS-II Dispensing Limits & OxyContin Tamper ResistantStrike Force
208271 250 230
150109
78 93 119 9548 57
108
199
447
686*
0
100
200
300
400
500
600
700
800
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H2015
Number of Heroin Deaths in Florida: 2000 to 2015*
# o
f H
ero
in D
eat
hs
Source: Florida Medical Examiners Commission 2015 Interim Report
* Projected Increase based on 2 X 1st Half of 2015
Number of Deaths Related to Fentanyl or Heroin in Broward County Florida: 2010-2015
3
11 1421
53
79
53 9 11
28
68
0
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 Cases98 % Cause of Death91 % w/Other Drugs
2015 Heroin Cases97 % Cause of Death85 % w/Other Drugs
CDC Prescribing Guidelines
1. Consider alternative therapies before prescribing opioids.
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.
CDC Prescribing Guidelines
lowest effective dosage
acute pain only prescribe a maximum of 3-day supply at the lowest effective dosage
prescribing naloxone
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.
Safe Disposal of Rx Drugs
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
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.
Overdose Prevention for Users
•Don’t mix drugs and alcohol
•Don’t use from an unknown source
•Don’t share needles
Overdose Prevention: Naloxone
Overdose Prevention: Naloxone
Overdose Prevention: The Good Samaritan Act
Overdose Prevention: Naloxone Training for Families and Paramours
Overdose Prevention: Post Overdose Reversal
•First responders should take patient to the Emergency Department immediately.
•Refer to treatment
How Do Address the Treatment Shortage ?
Beds Chairs
Treatment: Medication-Assisted Treatment
Stabilize brain chemistry
Relieve physiological cravings
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.
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 officials. These studies establish that SEPs do not increase crime or drug use, and provide a gateway to drug treatment and infectious disease prevention.
Myths: Syringe Exchange Programs
•1. Syringe Exchange Programs (SEPs) promote drug abuse.
•3. SEPs increase crime
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
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
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
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
