1. Prevention, Identification and Treatment of Opioid Use Disorders: A Personal Perspective Leah Bauer, MD Medical Director, Addiction Resource Center, Mid Coast Hospital Deanna Patient in Recovery, Addiction Resource Center January 28 th, 2016

2. Outline 2 Opioids in Maine and across the US Deanna’s story Tools for: –Prevention – Identification – Treatment Resources

3. Opioid Addiction In 2014, 10.3 million Americans reported using Rx opioids non-medically (was 4.9 mil in 1992) 1.9 million have an Rx opioid use disorder while 517,000 have heroin use disorder Admissions to addiction treatment programs for Rx opioids quadrupled from 2002-2012 3

4. Opioid Overdose Deaths www.nytimes.com

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6. Opioid Use in Primary Care 6 (JAMA IM, Dec, 2015)

7. Opioid use in Maine Maine has high opioid use rates 60.4 opioid pills per capita in 2013 In 2014 there were 208 drug overdose deaths and 131 motor vehicle related deaths In 2014, 89% of drug overdose deaths involved pharmaceutical drugs Maine has seen rapid rise in drug-affected babies Approx. 10% of live births 7

8. DEANNA’S STORY 8

9. Prevention Risk Factors –Age 16-45 (18-25 at highest risk) –Prior and current substance use (MJ, EtOH, benzos, cocaine) –Psychiatric history –Physical/sexual trauma –Family history of substance use disorder 9

10. Prevention Screening tools/risk assessment Prescription monitoring program Concurrent use of benzos or other sedating meds Treatment contract Informed consent, discuss risk of addiction Proper disposal of old meds 28 vs 30 day Rx

11. Identification of aberrant behaviors Behavior in and between office visits Physical exam findings Pill counts Random urine drug screens Screening tools Relationships with pharmacists

12. Aberrant Behaviors –Intranasal, IV use –Doctor shopping –Repeated lost Rx’s –Repeated early refills –Appearing sedated –Reports of selling/stealing meds –Urine tox results Rx not present Evidence of other substance use – Requesting specific meds – Requests for dose increases – Isolated instance of lost Rx, early refill – Reluctance to sign releases of information – Increased emotional dysregulation – Poor response/reluctance in considering alternative interventions 12

13. Buprenorphine Methadone Naltrexone AA NA Smart recovery TREATMENT Intensive outpatient Individual therapy Residential

14. Resources http://pcss-o.org Screening Tools –Opioid Risk Tool http://www.partnersagainstpain.com/printouts/Opioid_Risk_Tool.pdf –Drug Abuse Screening Test http://www.projectcork.org/clinical_tools/html/DAST.html –Current Opioid Misuse Measure http://www.opioidprescribing.com/documents/09-comm-inflexxion.pdf Sample opioid treatment contract –https://www.painedu.org/Downloads/AdditionalMaterials/Agreement_for_Opioid_Maintenanc e_Therapy_for_Non-Cancer_and_Cancer_Pain.pdfhttps://www.painedu.org/Downloads/AdditionalMaterials/Agreement_for_Opioid_Maintenanc e_Therapy_for_Non-Cancer_and_Cancer_Pain.pdf Treatment resources –SAMHSA http://www.samhsa.gov/medication-assisted-treatment/physician-program- data/treatment-physician-locatorhttp://www.samhsa.gov/medication-assisted-treatment/physician-program- data/treatment-physician-locator –AA/NA http://meetings.intherooms.com Safe medication disposal –http://www.disposemymeds.orghttp://www.disposemymeds.org

15. References Chen JH, Humphreys K, Shah NH, Lembke A. Distribution of Opioids by Different Types of Medicare Prescribers. JAMA Intern Med. Published online December 14, 2015. Brady KT, McCauley JL, Back SE. Prescription opioid misuse, abuse and treatment in the United States: An update. Am J Psychiatry 173:1 Jan 2016. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med 374:154-63; Jan 2016. http://www.maine.gov/dhhs/samhs/osa/data/cesn/Heroin_Opi oids_and_Other_Drugs_in_Maine_SEOW_Report.pdfhttp://www.maine.gov/dhhs/samhs/osa/data/cesn/Heroin_Opi oids_and_Other_Drugs_in_Maine_SEOW_Report.pdf www.samhsa.gov www.asam.org

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