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The Pale Horse Opioid use in Minnesota, 2014

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• Presented by Rick Moldenhauer, MS, LADC, ICADC, LPCC

Treatment Services Consultant/State Opioid Treatment Authority

P: (651) 431 2474

F: (651) 431 7449

Alcohol and Drug Abuse Division, DHS

PO Box 64977

St Paul, Minnesota 55164-0977

richard.moldenhauer@state.mn.us

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MARRCH Fall Conference 2013…..

Step 4: Made a searching and fearless moral inventory of

ourselves.

message messenger

Separated at birth?

I’m with the government, I’m here to help……

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Half Life

• Abbreviated as: t ½

• The time it takes for a substance to lose half of its pharmacologic activity

• Generally, 9 x t1/2 it’s gone

• Does NOT equal elimination half-life

• 0 1/1 100%• 1 ½ 50%• 2 ¼ 25%• 3 1/8 12.5% • 4 1/16 6.25%• 5 1/32 3.125%• 6 1/64 1.563• 7 1/128 0.781• n 1/2n 100(1/2n)

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Potency

• A measure of drug activity expressed in terms of the amount required to produce an effect of given intensity. A highly potent drug evokes a larger response at low concentrations. It is proportional to Affinity and Efficacy

• For our purposes, how strong the stuff is……don’t forget synergistic effect and contaminants

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Effective Dose

• Abbreviated as: ED-50

• An effective dose in pharmacology is the amount of drug that produces a therapeutic response in 50% of the people taking it, sometimes also called ED-50.

How long ago

What they took

How much/how potent

Intoxication & withdrawal

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Intoxication & withdrawal

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Intoxication/Withdrawal

0 2 4 6 8 10 12 14

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Tolerance=Adaptation

• Person’s response is decreased to same dose, requiring greater volume or frequency of application (tachyphylaxis end result, as with amphetamines “amped out”)

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Drugs make you feel something you normally don’t

• T ½

• Effective Dose: ED 50

• Lethal Dose: LD 50

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Opioids

• Contains morphine (natural) heroin (semi-synthetic), diverted methadone (synthetic), other prescription opioid drugs

• Water soluble, detectible by UDS

• Agonist and antagonist properties at mu and kappa-opioid receptor sites

• Used an analgesics, anesthetics, anti-diarrheal, cough suppressants

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20SOURCE; DAWN, 2013

Heroin vs. other opiate admission 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Heroin vs. other opiate admission 1998-2013 by gender

Source: DAANES, PMQI, MN DHS 2014

Heroin vs. other opiate admission for pregnant women, 1998-2013

Source: DAANES, PMQI, MN DHS 2014

2010 US Census data, MN race by %

Source: MN State Demographic Center

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Other opiate admission by race 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Other opiate admission by race, not counting white, 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Other opiate admission by age 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Heroin admission by race 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Heroin admission by race, not counting white, 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Heroin admission by age 1998-2013

Source: DAANES, PMQI, MN DHS 2014

Number of Deaths From Poisoning, Drug Poisoning, and Drug Poisoning Involving Opioid Analgesics—United

States, 1999–2010

MMWR, March 29, 2013http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a7.htm?s_cid=mm6212a7_e

Prescription Related Deaths in the US, 1999-2010

Source: CDC Wonder, 2014

Sold vs. used…..

Source: CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6

Sold vs. used…..

Source: CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6

Total opiate related deaths in MN, 2000-2010 by four largest race

categories

Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011

Raw numbers

Total opiate related deaths in MN, 2000-2010 by select age categories

41.9 avg. age of death

of opiates

Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011

Raw numbers

Compared to other substances in MN….

Change BetweenPrimary Substance of Abuse Count Col % Count Col % Count Col % Count Col % Count Col % CY2009 and CY2013Alcohol 27,633 55.4 26,134 53.2 25,109 50.6 24,248 47.7 22,748 44.4 -17.7Methamphetamine 3,440 6.9 3,934 8.0 4,249 8.6 5,299 10.4 7,095 13.9 106.3Cocaine 633 1.3 551 1.1 615 1.2 496 1.0 443 0.9 -30.0Crack 1,890 3.8 1,581 3.2 1,474 3.0 1,362 2.7 1,167 2.3 -38.3Marijuana 9,496 19.0 9,431 19.2 9,058 18.3 9,137 18.0 8,788 17.2 -7.5Heroin 2,181 4.4 2,282 4.6 3,336 6.7 4,527 8.9 5,128 10.0 135.1Other Opiates 3,585 7.2 4,222 8.6 4,571 9.2 4,479 8.8 4,379 8.6 22.1Other 732 1.5 827 1.7 953 1.9 1,076 2.1 1,092 2.1 49.2Unknown 262 0.5 160 0.3 223 0.4 243 0.5 363 0.7 38.5Total 49,852 49,122 49,588 50,867 51,203

Substance Abuse Treatment Admissions for Minnesota Residents Primary Substance of Abuse by Admission YearSource: Minnesota Department of Human Services, ADAD, DAANES (10/6/2014)

CY2009 CY2010 CY2011 CY2012 CY2013

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Opiate intoxication

• Directly related to volume and strength consumed

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miosis

• Constricting of the pupil, 2-3mm

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Slurred speech

• Inability to enunciate words, broken sentence structure and vocabulary choice

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fatigue

• That state, following a period of mental or bodily activity, characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness, sleepiness, or irritability.

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Stupor or coma

• The partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation

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Impairment in attention

• Inability to focus on objections or discussions, e.g. can’t “track”

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Impairment in memory

• Inability to recall short or long term memory, may also have difficulty with recognition

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Opioid withdrawal

Rarely life threatening• Looks like bad case

of the flu

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mydriasis

• Widening of the pupil, 7-8mm, slow and sluggish to respond

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lacrimation

• Watering of the eyes, shedding tears

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rhinorrhea

• Flowing, nasal discharge

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diaphoresis

• Perspiration, especially profuse perspiration, e.g. “sweating”

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Nausea/emesis

• Upset stomach and vomiting

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diarrhea

• A morbidly frequent and profuse discharge of loose or fluid evacuations from the intestines e.g. “the shits, the hershey squirts, the green apple two-step”

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Muscle aches

• Burning pain in the muscle body

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fever

• A rise in body temperature above normal usually as a natural response to infection. Typically an oral temperature greater than 100.4 degrees Fahrenheit constitutes a fever.

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piloerection

• Erection of the hair, e.g. “hair standing on end”

Social confusion

Normal (Merriam-Webster)

• according with, constituting, or not deviating from a norm, rule, or principle

• conforming to a type, standard, or regular pattern

Average (Merriam-Webster)

• a number that is calculated by adding quantities together and then dividing the total by the number of quantities

• a level that is typical of a group, class, or series : a middle point between extremes

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normal average

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normal average

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normal average

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normal average

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