1. Opioid Poisoning Learning Session
Matthew Moy
Safe Kids: Poison Prevention Month
February 14th , 2018

2. How Opioids Work
Opioids attach to receptors in the brain and sends signals to the brain of the “opioid effect” which blocks pain, slows breathing, and has a general calming and anti-depressing effect. Opioids can activate receptors because their chemical structure mimics a natural neurotransmitter, which then allows the drugs to lock onto and activate nerve cells. Opioids target the brain's reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who misuse drugs and teaches them to repeat the behavior. Our brains are wired to make sure that we repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.

3. A National Epidemic 2016 Causes of Injury Deaths:
Now the leading cause of injury in the US

5. Opioid Problem in Illinois

6. Opioid Overdose Drivers: Increased Prescription
Source Pezalla et al Secular trends in opioid prescribing in the USA

7. Opioid Overdose Drivers: Influx of Cheap Heroin

8. Increased Availability of Lethal Synthetic Opioids
Lethal Doses:
Morphine = 1 pea = 1x
Heroin = 1 sunflower seed = 2x
Fentanyl = 1 sesame Seed = 100x
Sufentanil = 1 grain of sand = 500x
Carfentanil = .5 grains of salt = 10,000x

9. Collateral Damage: Children & Adolescents
Unintentional harm
Easy access to opioids at home
Intentional harm
Adolescents
Pre and post natal development
Neonatal abstinence syndrome
Neonatal withdrawal

10. Opioid Overdose in Children
From a study of 31 children’s hospitals
Significant increase in admissions rate: from 6.7 to 10.9 per 10,000 admissions

11. Opioid-Related Admissions Requiring PICU Care

12. Opioid-Related Hospital Admissions
Overall
43% of child and youth opioid-related hospitalizations require PICU care
Ages 1-6 years
1/3 of opioid-related hospitalizations
19.5% involve methadone
Ages years
2/3 of opioid-related hospitalizations
9.8% involve methadone
4.4% involve heroin

13. Prevention: What Can We Do?
Use Data to understand the problem
Statewide Unintentional Drug Overdose Reporting System (SUDORS)
Collects information on opioid-involved OD fatalities in 17 counties (about 80% of opioid OD deaths in IL)
Data comes from coroner reports
Toxicology
Autopsy
Law Enforcement
Helps understand emerging trends and factors leading up to the OD and can be used to develop prevention approaches

14. SUDORS July-Dec 2017 Sex N % Age Male 749 76.0 Female 236 24.0 Total
985
100.0
Age
< 15 3
0.3
15 to 24 86
8.7
25 to 34
250
25.4
35 to 44
219
22.2
45 to 54
255
25.9
55 to 64
149
15.1
65 + 23
2.3

15. SUDORS July-Dec 2017 Prescription vs. Illicit Opioid* N % Rx only 134
14.0
Illicit only
637
66.4
Rx/Illicit combination
149
15.5
Unknown 39
4.1
Total
959
100.0
*Mean number of substances detected by toxicology: 8.13

16. SUDORS July-Dec 2017 Drug present* N % Fentanyl/Any fentanyl analogs
653
66.3
Heroin or 6-MAM
364
37.0
Alcohol
267
36.5
Cocaine
353
35.8
Benzodiazepine
343
34.8
Methadone 70
7.1
Methamphetamine 38
3.9

17. SUDORS July-Dec 2017 Route of Delivery* N % Unknown 462 46.9 Injection
248
25.2
Snorting
110
11.2
Smoking 68
6.9
Transdermal 2
0.2
Ingestion 77
7.8
Suppository
0.0
*Not mutually exclusive

18. Prevention: What Can We Do?
At home/personal life:
Store opioids securely
Safely dispose of un-needed opioids
Ask for alternatives to opioids when being prescribed
Be aware of signs of potential opioid abuse
Stay connected to those using opioids (monitor)
Mood swings, excessive sleepiness, slurred words, missing spoons, shallow breathing, constipation, pin point pupils

19. Prevention: What Can We Do?
At work:
Follow prescribing protocols designed to reduce unnecessary opioid prescriptions
Utilize Prescription Drug Monitoring Program (PDMP) for prescription history
Follow up with prescribed opioid usage (was it filled, used…)
Counsel parents on safe storage of opioids
Mood swings, excessive sleepiness, slurred words, missing spoons, shallow breathing, constipation, pin point pupils

20. Prevention: What Can We Do?
In our communities:
Support funding for evidence-based treatment
Participate in/organize educational forums
Participate in/organize safe drug disposal events
Support availability of Naloxone (Narcan) medication to reverse opioid overdose
Mood swings, excessive sleepiness, slurred words, missing spoons, shallow breathing, constipation, pin point pupils

21. Getting Help for Those who Misuse Opioids
SAMHA’s National Helpline, HELP:
Confidential
Free
24-7 hours/365 days
English and Spanish
Provides referrals to local treatment facilities, support groups, and community-based organizations
Mood swings, excessive sleepiness, slurred words, missing spoons, shallow breathing, constipation, pin point pupils