Todd Davis, MD, MMM EVP & CMO, CaroMont Health The Opioid Epidemic Todd Davis, MD, MMM EVP & CMO, CaroMont Health

History and Pharmacology of Opioids

Poppy First Cultivated in Mesopotamia around 4000 BC Poppy seed pod scratched and resulting fluid dried into Opium Ancients used opium for analgesia (pain killer) and to alter mood

Morphine first extracted from opium in 1805, Germany Morpheus Morphine first extracted from opium in 1805, Germany Morphine was commercialized and sold as a panacea, widely available in markets

Commercially available opioids used widely in late 1800’s and early 1900’s for all types of maladies

Opioid Pharmacology Opioids are chemicals that bond to specific receptors in the brain Opioids are similar in action to endogenously produced chemicals called “Endorphins” Synthetic opioids are much more powerful and long acting than natural endorphins

Signs and symptoms that occur with cessation of the drug Tolerance Decreased subjective and objective effects to the same amount of drug over time requiring increasing the amount to achieve the same effect Dependence Signs and symptoms that occur with cessation of the drug Addiction A CHRONIC DISEASE of the brain manifested by compulsive substance use despite harmful consequences. 75% of people with addiction have a Mental Illness

Addiction Is a Chronic Disease Is NOT a Choice Requires Life-long treatment Brain’s “wiring” or neurochemistry is altered Judgment, decision making, learning, memory, behavioral control ALL changed Any person can develop an addiction if vulnerable and stressed

Risks for Addiction Family History of any substance abuse - including alcohol Personal history of substance abuse Age less than 45 years History of preadolescent sexual abuse Psychological Disorders including: ADD, ADHD, OCD, Bipolar disease Depression Stress: Emotional, Financial, Pain, Injury No-one wants aspires or plans to be a heroin addict

Withdrawal Withdrawal is a condition opposite of the effects of the drug and addicted state Acute Withdrawal - 5 to 7 days Chronic/Sub-Acute Withdrawal - Months to years Permanent Rewiring - Depression, Stress Response, Craving

Opioid Epidemic US uses 80% of world’s opioids (4.4% of the world population) US life expectancy has dropped due to opioid overdoses Opioid overdose deaths have quadrupled since 2000 and are the leading cause of accidental death 130 people die daily from opioids

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