Addiction and dependence Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account.

Slides:



Advertisements
Similar presentations
The purpose is not to imply everyone on controlled substances will become addicted!!! Everyone on controlled substances is, however, at increased risk.
Advertisements

PAIN AND ADDICTION Steven Rapaport, MD Attending Physician Comprehensive HIV Center Saint Vincent’s Catholic Medical Center A Local Performance Site of.
Opioid Therapy of Chronic Pain: Evolving Trends Nociception Other physical symptoms Physical impairments NeuropathicPsychological Social isolation mechanismsprocessesFamily.
Medicines and Drugs Chapter 23.
Risks of alcohol and other drugs. What Is a Drug? Any chemical substance that causes a physical or psychological change is called a drug. Drugs are classified.
Medicines are classified based on how they work in your body.
The Roles of Medicines (1:40) Click here to launch video Click here to download print activity.
Definition: Drug addiction involves compulsively seeking to use a substance, regardless of the potentially negative social, psychological and physical.
Pain Management for Patients in OTPs. Pain Prevalence Study of (2) populations 1 –(390) pts in MMT –(531) pts in short term residential –Prevalence of.
Anxiety and Depression in Paediatric Palliative Care Dr Emma Heckford July 17 th 2012 Disclaimer: Whilst every effort has been made to ensure that the.
Warm-up Finish up your anti-tobacco or anti-alcohol ad. Prepare yourself to present to the class. Presentation should include:  Description of your ad/
Concerns About Addiction: Bringing Clarity to Confusion about Addiction Terminology Aaron M. Gilson, MS, MSSW, PhD Research Program Manager/Senior Scientist.
Vulnerability to Opioid Withdrawal Symptoms Among Chronic Low Back Pain Patients Subjects. In 2008, student research assistants consented and enrolled.
CH. 24 Illegal Drugs Health Ed.. Drugs Refers to dangerous/ illegal substances Drugs are grouped according to their affects on the body.
B ENZODIAZEPINE DEPENDENCE. WHO - ICD 10 C RITERIA FOR S UBSTANCE D EPENDENCE A definite diagnosis of dependence syndrome should usually be made only.
Opiates in Chronic Pain Dr S Vas, Barnsley VTS October 2014.
Medications for Pain: What You Need to Know for Treatment in Workers’ Compensation Suzanne Novak, MD, PhD 5/17/07.
Opioid Dependence Anne Kalvik Pearl Isaac. Learning Objectives 1.To develop an understanding of opioid dependence issues including tolerance, abuse, toxicity,
FIVE MINUTES TO MAKE A DIFFERENCE Presentation by: Mark Barnes.
Pain Management Laura Bergs FNP. Definition of Chronic Pain Anyone with pain greater than 3 months Anyone with pain greater than 3 months Pain An unpleasant.
PERCODAN ABUSE *And Other Prescription Abuse* Kirsten Neilson Life, Society & Drugs Section 004.
Opioid Use in Workers’ Compensation Suzanne Novak, MD, PhD November 2008.
The Role of Medicines Lesson #1 Ch. 19 Pg
Texas State Board of Medical Examiners Bruce A. Levy, M.D., J.D.
You have 5 min…ask three people “What is the first thought that comes to mind when they hear the word drug ?”
Pharmacotherapy III Fall The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated.
C C E E N N L L E E Pediatric Palliative Care Pain Physiology Pain is a complex physiologic process Transduction Transmission Perception of pain Modulation.
Role of Medicine.
Medicines and Drugs.  The Role of Medicine  Medicines- drugs that are used to treat or prevent disease or other conditions  Drugs- substances other.
Adjuvants or Co-analgesics Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account.
Treatment in HIV/AIDS Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account.
WHO Analgesic Ladder Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account.
Special situations Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account for.
Non-pharmacological treatment Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot.
Treatment: other opioids Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account.
Breakthrough, emergency, and incident pain
Medicines are divided into classes and have different effects on different people.
Mechanisms of pain Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account for.
Side effects and toxicity of analgesics Disclaimer: This presentation contains information on the general principles of pain management. This presentation.
Pain Assessment Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account for individual.
Introduction to pain Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account.
Medicine. What is medicine? 1. Medicine – used to treat or prevent diseases or other health conditions 2. Drugs – substances other than food that change.
Drug Misuse, Abuse and Addiction Lesson 2-3. BELL RINGER O Get out Student Journal O Pg. 5, Lesson 2, Journal Entry O Write a few sentences about what.
Pain Management: Narcotics, Implantable Therapies Maher Fattouh MD Adjunct Assistant Clinical Professor University Wisconsin Medical Director, Advanced.
PRESCRIPTION PAINKILLER ABUSE AND ADDICTION KAREN REYES BIOLOGY UNIVERSITY OF HOUSTON-DOWNTOWN.
Chapter 23 Medicines & Drugs Pg Chapter 23, Lesson 1 The Role of Medicines.
Chronic Pain Management Harald Lausen, DO, MA FCM Clerkship SIU School of Medicine.
It’s not easy trying to beat a drug addiction and it just got harder in the Cowichan Valley. One of the two physicians in Duncan who were authorized to.
Substance Abuse Chapter 11. Substance Abuse  Self-administration of a drug in a manner that does not conform to the norms within the patient’s own culture.
Prepared by Dr. Ramin Safakish, MD, FRCPC – March 2016.
THE ROLE OF MEDICINES CHAPTER 19 LESSON 1 Pages
Addressing the issue: Prescription Drug Misuse in North Carolina
Clinical Opiate Withdrawal – Symptom Management Protocol
Opioids for the management chronic non-cancer pain in Primary Care:
Pain management in palliative care 2
Make Sure All Notes Are filled in
Ch. 19 Medicines and Drugs.
Presented by J. Arzaga, MSN, RN
Medicines and Drugs.
addiction Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.
Addiction: An obsession, compulsion, or excessive physical, or psychological dependence.
Substance abuse reveiw
Chapter 19: Medicines and Drugs
Todd Davis, MD, MMM EVP & CMO, CaroMont Health
Assessing Opioid Use Disorder, part 1
Drug Use- a high risk behavior
Background Cancers are among the leading causes of morbidity and mortality worldwide, responsible for 18.1 million new cases and 9.6 million deaths in.
Medicines and Drugs.
Acute Pain Management & Addiction
Presentation transcript:

Addiction and dependence Disclaimer: This presentation contains information on the general principles of pain management. This presentation cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician, or health care provider, to determine the best course of treatment for the patient. Treat the Pain and its partners assume no responsibility for any injury or damage to persons or property arising out of or related to any use of these materials, or for any errors or omissions.

Objectives Discuss the difference between addiction and dependence Review withdrawal, pseudoaddiction, and tolerance 2

Research in the last decade has shown… Risk of developing addictive behaviors as a consequence of medical use of opioids for chronic cancer pain is low Patients, family members, and healthcare workers commonly overestimate the risk of addiction Patients, family members, and healthcare workers often confuse physical dependence and addiction Together, these concerns contribute substantially to physician reluctance or unwillingness to prescribe opioids and patient reluctance to use them Oxford Textbook of Palliative Medicine (2010)3

So, what are the rates of addiction? What proportion of patients using opioids to manage chronic cancer pain will become addicted to opioids? – A. 40% – B. 25% – C. <10% – D. <1% – E. <0.5% 4

Risk of addiction in medical use of opioids The correct answer is E: less than one-half of 1 percent According to the World Health Organization: – A systematic review of research papers concludes that only 0.43% of patients with no previous history of substance abuse treated with opioid analgesics to relieve pain abused their medication and only 0.05% developed dependence syndrome Fishbain et al (2008): Among chronic pain patients with no history of opioid abuse/addiction, incidence of abuse/addiction is 0.19% Ensuring balance in national policies on controlled substances: guidance for availability and accessibility of controlled medicines. World Health Organization (2011). What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Fishbain DA et al: Pain Med:

Defining addiction and dependence Addiction: Psychological dependence leading to craving, impaired control over drug use, and compulsive use to get psychic effects despite harm – Behaviours associated with addiction Compulsive drug-seeking Unauthorized use or dose escalation Use despite harm to self or others Oxford Textbook of Palliative Medicine (2010)6

Dependence Dependence: The phenomenon of withdrawal when an opioid is abruptly discontinued – Physical dependence is a normal response to chronic therapy – Prevent withdrawal by titrating the opioid dose down slowly Reduce daily dose by 25% each day Oxford Textbook of Palliative Medicine (2010)7

Withdrawal Signs and symptoms of withdrawal Anxiety Nervousness Irritability Alternating chills and hot flushes Wetness: salivation, watery eyes, runny nose, sneezing, sweating, and gooseflesh At peak intensity of withdrawal, patients may experience: – Nausea and vomiting – Abdominal cramps – Insomnia – Multifocal myoclonus or abrupt spasms (rare) Oxford Textbook of Palliative Medicine (2010)8

Pseudoaddiction When the dose of opioids is not enough to relieve pain, some patients may become anxious about opioid availability and may demonstrate some behaviours that you see in patients with addiction, such as – Asking for the next dose before it is due – Taking medications not prescribed to them – Taking illegal drugs – Using deception to obtain medications Oxford Textbook of Palliative Medicine (2010)9

Pseudoaddiction These behaviours go away after the dose has been increased and pain has been relieved It is important to distinguish pseudoaddiction from addiction: patients with pseudoaddiction stop seeking medications once their pain has been effectively treated Oxford Textbook of Palliative Medicine (2010)10

Tolerance Decreasing response to a drug as a consequence of its continued use An increased dose is required to achieve a similar effect Tolerance to opioids is not common – Increases in opioid requirements are usually related to disease progression Oxford Textbook of Palliative Medicine (2010)11

Take home messages Risk of developing addictive behaviors as a consequence of medical use of opioids for chronic cancer pain is low The risk of addiction is commonly overestimated by patients, family and healthcare workers alike Healthcare workers should be able to distinguish pseudoaddictive behaviors from addictive behaviours When discontinuing morphine, avoid symptoms of withdrawal by titrating the opioid dose down slowly 12

References African Palliative Care Association. Beating Pain: a pocketguide for pain management in Africa, 2nd Ed. [Internet] Available from: African Palliative Care Association. Using opioids to manage pain: a pocket guide for health professionals in Africa [Internet] Available from: Amery J, editor. Children’s Palliative Care in Africa [Internet] Available from: Africa-Full-Text.pdf Kopf A, Patel N, editors. Guide to Pain Management in Low-Resource Settings [Internet] Available from: pain.org/files/Content/ContentFolders/Publications2/FreeBooks/Guide_to_Pain_ Management_in_Low-Resource_Settings.pdf The Palliative Care Association of Uganda and the Uganda Ministry of Health. Introductory Palliative Care Course for Healthcare Professionals