1. Opiates: Addiction to Recovery Section 1
Dominic Vangarelli, M.A., C.A.D.C., ICADC

2. Opiates: Addiction to Recovery
Objectives:
Recognize symptoms of acute opiate withdrawal.
Understand Post Acute Withdrawal Syndrome.
Identify Stages of Change.
Identify types of Medication Assisted Therapies
Outline the Continuum of Care.
Opiates: Addiction to Recovery

3. Patient Story

5. Family Symptoms of Addiction
Chemically Dependent Person: Family Members :
Family Symptoms of Addiction
Denial
Rationalization of use
Minimization of the consequences of use
Making excuses/justifications for use
Worrying about personal reputation and what others in the community are thinking about the family
Agreeing with the excuses the addict/alcoholic makes and blaming other people
A denial that the family has been affected… “It’s his/her problem, not mine, fix them!”
Preoccupation
2. Preoccupation
The addict/alcoholic becomes consumed by cravings and thoughts of using/not using
The family becomes preoccupied with the addict/alcoholic
They begin to feel as if they were walking on eggshells, wondering, waiting, anticipating for any outburst or binge use
3. Attempt to Control
Numerous attempts and desperate actions to try and control the use of alcohol/drugs and subsequent failures and short comings
The family members try and control or force situations onto the addict/alcohol in a desperate attempt to control them and prevent crisis
4. Increased Tolerance
4. Increased Tolerance
Tolerance for the alcohol/drugs significantly increases and this is the hallmark of chemical dependency
Enabling behaviors increase, family members begin to “ignore” behaviors and allow the addict/alcoholic to get away with more unacceptable behavior
5. Isolation
The addict/alcoholic begins to isolate himself/herself and only associate with people who use
They begin to use alone and avoid people
They begin to avoid their family members
The family members stop socializing with other people and other families
The family members try to isolate themselves from the addict/alcoholic “out of sight, out of mind”
6. Guilt & Shame
The addict/alcoholic keeps his/her use hidden from others and then battles the shame and guilt with more drinking or drugging
They start to feel the shame and guilt from how their drinking/drugging affects the family and others
The family members keep the guilt and shame in the house, they will keep their embarrassment to themselves and avoid contact with others

7. The Epidemic

9. News article in the Daily Item, Sunbury, PA
Between 2014 and July 2017:
Drug overdoses killed nearly 11,000 in Pennsylvania
In each year, the death toll grew:
2,489 in 2014,
3,505 in 2015,
4,812 in 2016,
(according to the Pennsylvania Coroners Association).
Described opiate addiction as the leading killer of Americans under the age of 50.

10. Pennsylvania drug overdose deaths outpacing all other states
The number of drug overdose deaths in Pennsylvania is increasing faster than drug deaths in any other state.
This increase was the largest among the 50 states. Florida ranked second.

11. Pennsylvania’s Overdose Rates Skyrocket
One major reason for the spike is the presence of fentanyl in the street drug supply.
Fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine, is being mixed with heroin
Sometimes without the knowledge of drug users.
Even small amounts can lead to a deadly overdose.

12. Rate of Drug-Related Overdose Deaths per 100,000 people in Pennsylvania Counties,
2016

13. Factors
Fueling
The Epidemic?

14. Pennsylvania RX Trends

15. Top 5 CPD’s Distributed Nationwide in 2016
1 - Hydrocodone (7.87 billion dosage units)
Estimated U.S. consumes 99% of the world’s hydrocodone
2 - Oxycodone (4.99 billion dosage units)
3 - Amphetamine (1.44 billion dosage units)
4 - Methylphenidate/Ritalin® (958 million dosage units)
5 - Morphine (766 million dosage units)

16. Heroin: inexpensive, pure and available
Drug Pharmacy price Street price OxyContin (oxycodone): $1-$2 per 30mg tablets $30-$50 per pill Vicodin (hydrocodone/acetaminophen): $17 for 60 (5mg tablets) $7-$8 for 10mg $25-$30 for 30 mg Percocet (oxycodone/acetaminophen): $70 for 60 (10mg tablets) $1 per mg Suboxone (Buprenorphine): $150 for 30 (8mg tablets) $15-$20 per strip $20 per tablet Methadone: $16 for 60 (40mg tablets) $1 per mg Heroin: n/a $10 bag

17. 1 Bag = about 100mg
1 Bundle = 10 bags = 1gm
Average reported use per day:
10 “Bags” (Bundle)
Cost of 1 “Bag” = $10

24. Stimulants are a significant and growing threat
Between 2010 and 2016, the volume of heroin seized by law enforcement equaled more than 38,000 kilograms.
The volume of cocaine and methamphetamine exceeded 596,000 kilograms.
An average of 15.5 kilograms of stimulants seized for every 1 kilogram of heroin.
The rate of stimulant prescribing is increasing by as much as 50% in some states.
Prescription drug monitoring programs aren’t tracking the drug class to identify potential misuse
CONCERN:
Stimulants are a significant and growing threat

25. A Chronic Disease:
Biological
Psychological
Social
and
Spiritual