Jeanne Keen, RN, CADC Program Administrator

Opium Aunti, Big O Heroin H, Horse, Smack Morphine Dreamer, Morf, God’s Drug Codeine School Boy Oxycodone Hillbilly Heroin, OC, Oxycotin Hydrocodone Hydro, Tabs, Vikes, Lortab Hydromorphone D, Dillies, Dust, Juice, Dilaudid Oxymorphone Opana, OPs Methadone Fizzies, Wafer

History of Opiate Use and Abuse

The problem of cough has been solved by using Heroin syrup!

1887 Ad for the opiate morphine Mrs. Winslow's Soothing Syrup was an indispensable aid to mothers and child-care workers. Containing one grain (65 mg) of morphine per fluid ounce, it effectively quieted restless infants and small children. It probably also helped mothers relax after a hard day's work. The company used various media to promote their product, including recipe books, calendars, and trade cards such as the one shown here from 1887 (A calendar is on the reverse side.). Mrs. Winslow's Soothing Syrup

Heroin (opiate) addiction is a disease – a “metabolic disease” of the brain with resultant behaviors of “drug hunger” and drug self- administration, despite negative consequences to self and others. Heroin addiction is not simply a criminal behavior or due alone to antisocial personality or some other personality disorder. 1963

DRUG ADDICTION IS A COMPLEX ILLNESS

 Mild: social, recreational, occasional  Moderate: negative consequences but continue to use  Severe: negative consequences PLUS: ◦ Tolerance ◦ Withdrawal ◦ Compulsive use

 Initial decision to drink or use is voluntary  Over time, changes in the brain caused by repeated use can impact ◦ self-control ◦ ability to make sound decisions ◦ PLUS, causes intense cravings  People who abuse drugs can stop more easily, but they may not think they have a problem!  People with addiction can choose to stop, but it is hard work, and some are not successful

 Chronic  Often relapsing  Progressive  Causes compulsive drug seeking  Causes use despite harmful consequences  Changes the structure and function of the brain  Can be fatal is left untreated.

Addiction is a brain disease, not a weak will. The disease of addiction causes changes in brain chemistry. These brain changes directly affect thinking, judgment, planning, sequencing, memory... The brain controls feelings, behavior, and habits. Behavior is VISIBLE; we assume behavior = character. Addiction changes the chemistry of the brain.

 Opiates affect the way your brain functions ◦ Imitating your brain chemistry ◦ “fools” your brain to send abnormal messages ◦ Over-stimulating the “reward circuit”

 The limbic system has to do with survival (eating, spending time with loved ones)  Drugs flood the brain with DOPAMINE in the LIMBIC system - part of the brain that controls ◦ Movement ◦ Emotion ◦ Motivation ◦ Feelings of pleasure 38

 Drugs cause euphoria or a “high”  This brain response “teaches” people to repeat the behavior of using/abusing drugs  Then the brain stops making its own dopamine and the receptors get damaged, so you need more drug to get high  Now you need the drug to feel normal 39

becomes “They have the disease of addiction. How can we reach them through this disease and support them to overcome it??” “They just need to stop partying and fly right”

 Detoxification  Counseling – inpatient and outpatient ◦ Individual ◦ Family ◦ Group  Self-Help  Pharmacological

◦ Prevent withdrawal symptoms ◦ Reduce drug craving ◦ Normalize any physiological functions disrupted by drug use ◦ Target treatment agent to specific site of action, receptor, or physiological system affected or deranged drug of abuse.

 Generic Name: methadone hydrochloride  Marketed As: Methadose  and Dolophine  (among others)  Purpose: To discourage illicit opioid use due to cravings or the desire to alleviate opioid withdrawal symptoms.  Class : agonist  Amount: maintenance dose of 80 to 120mg  Method: mouth  Frequency: once a day

HeroinMethadone  IV  Immediate effect  Lasts 3-6 hours  Euphoria first 1-2 hours  Withdrawal after 3-4 hrs  Oral  30 minutes for effect  hours  No euphoria  Withdrawal after 24 hrs

Methadone Maintenance is approved by the US FDA for treatment of heroin addiction because an efficient oral dose of methadone given once daily to a heroin addicted person effectively prevents opiate withdrawal and associated cognitive and behavioral problems

 In 1991 there were 40 million prescriptions for pain killers world wide. In 2001 there were 180 million prescriptions written. The vast majority of these prescriptions are used in the U.S.  Painkillers are now the most commonly abused prescription drugs.  Young adults, ages show the most opiate abuse and increase in abuse.  From 1985 and 2001 the number of people abusing opiates rose from ½ million to 2.5 million.  Deaths from opiate use rose from 160 percent from 1999 to 2004.

 Abuse of opiates causes more deaths than heroin and cocaine combined.  Emergency Room visits rose 153 percent from 1995 to  About 1 in 5 teens use opiates to get high.  2,500 teens abuses prescription drugs for the first time each day.  Experts predict that abuse of prescription drugs will increase by 190 percent by 2020.

 Misconceptions about their safety  Increasing environmental availability  Varied motivations for their abuse

 KASPER Reports  Increased Regulations for Pain Clinics

 Heroin arrests have increased 2,334 percent from 32 in 2008 to 779 in 2012 in Louisville – LMPD  Seizures of heroin are up 6,688 percent  LMPD blames 80 percent of burglaries and thefts on heroin addicts  JADAC - 90 percent of calls are heroin related

 There were 22 heroin related deaths in Lexington in 2012  Year to date in Lexington there have been 38 heroin related deaths.  50 people died from heroin overdose in Louisville last year (2012).

Krocodil is coming …..