Metropolitan Drug Enforcement Unit Prescription Drugs / Heroin
2015
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Trends are constantly changing in the area of drug
abuseespecially with our youth. Popularity of drugs change with
time. Mainstay drugs are getting more potent.
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High Grade Marijuana Cocaine/Crack Cocaine Prescription Drugs
Heroin Club Drugs Methamphetamine Ketamine Alcohol
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Where there is one, you will find the other
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Ranks as the second highest threat in our region. More
Americans abuse prescription drugs than the number of Cocaine,
hallucinogen, Heroin, and inhalant abusers combined. The increase
in abuse of prescriptions has occurred the most among younger age
groups. There are many reasons kids are abusing prescription drugs:
Think the drugs are safe since the are medicine. Think the drugs
are safe since the are medicine. Dont think the drugs are
addictive. Dont think the drugs are addictive. According to a DEA
Milwaukee District Office, 2012
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Diverted Pharmaceuticals: Oxycodone Oxycodone Oxycontin most
prevalent Oxycontin most prevalent Hydrocodone Hydrocodone
Hydromophone Hydromophone Methadone Methadone
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Each day, 46 people die from an overdose of prescription
painkillers* in the US. Health care providers wrote 259 million
prescriptions for painkillers in 2012, enough for every American
adult to have a bottle of pills.
http://www.cdc.gov/vitalsigns/opioid-prescribing/.
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More overdose related deaths from prescription More overdose
related deaths from prescription drugs than any illegal street
drug. drugs than any illegal street drug.
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Health care providers in different parts of the country don't
agree on when to use prescription painkillers and how much to
prescribe. Some of the increased demand for prescription
painkillers is from people who use them non-medically (using drugs
without a prescription or just for the high they cause), sell them,
or get them from multiple prescribers at the same time. Many states
report problems with for-profit, high-volume pain clinics
(so-called "pill mills") that prescribe large quantities of
painkillers to people who don't need them medically.
http://www.cdc.gov/vitalsigns/opioid-prescribing/
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Mom and Dad, Grandma, Grandpa, Aunts, Uncles, friends, friends
of friends are the number #1 dealer to kids! Theft from medicine
cabinet: 49% of teens obtained prescription drugs from a friend.
20% of parents have given their teen an un-prescribed drug. Most
people dont keep track of the number of pills they have. STOP Rx
ABUSE Ignorance is NO excuse, by Dr. Raj Arangarasan, National
Institute on Drug Abuse, 2013
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Prescription opioid pain medications such as OxyContin and
Vicodin can have effects similar to heroin. The No. 1 sign that
someone will use heroin is that he or she abused prescription
painkillers like Vicodin and Oxycodone.
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OxyContin abusers switch to Heroin due to the cheaper cost for
the same high. Pills can run $1.00 per milligram so a single pill
can cost as much as $80.00. A dose of Heroin is $20.00.
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MONITOR - Restrict access to prescription drug medicine
cabinets. Lock up the prescription! DISPOSE Properly dispose (drug
collection) expired medications. ENGAGE - Talk to your kids about
the dangers of drug abuse. 50% less likely to abuse prescription
drugs when teens learn the risks of drugs from their parents. 50%
less likely to abuse prescription drugs when teens learn the risks
of drugs from their parents. STOP Rx ABUSE Ignorance is NO excuse,
by Dr. Raj Arangarasan, National Institute on Drug Abuse, 2013
Heroin: Heroin: Most Common Drug Death Most Common Drug Death
Record Number of Overdoses Record Number of Overdoses
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The average age at first use among recent initiates aged 12 to
49. The average age at first use among recent initiates aged 12 to
49. 22.1 years old is the average age. 22.1 years old is the
average age.
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Heroin can be injected, inhaled by snorting or sniffing, or
smoked. All three routes of administration deliver the drug to the
brain very rapidly, which contributes to its health risks and to
its high risk for addiction. Drug-seeking, no matter the
consequences.
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Heroin users are using a recreational mentality. You can start
by smoking or snorting. Twenty or 30 years ago, Heroin was 6 to 10
percent pure, so if people wanted to get high, the only choice they
had was to inject it. These days, Heroin is 50 to 60 percent pure,
so most users start by snorting it, then gradually progress to
smoking and injecting it. Ultimately you meet bad people or just
die without intervention.
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Danger with Heroin use is lack of control. Heroin can range
from 7% to 80% purity. Heroin can range from 7% to 80% purity. This
lack of control of purity can result in hot shots of Heroin. This
lack of control of purity can result in hot shots of Heroin.
Overdose from the hot shot dose because the purity is too high.
Overdose from the hot shot dose because the purity is too
high.
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Periods of extreme euphoria followed by extreme depression.
Sedated appearance. Unkempt appearance. Dramatic weight loss.
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Metropolitan Drug Enforcement Unit 262-548-7148
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Treatment It really does work
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2010: 7 million using psychotherapeutic drugs Pain killers 5.1
million Stimulants - 1.1 million Tranquilizers 2.2 million
Sedatives - 0.4 million over 80% all detox admission are for IV
drug use How Did We Get Here ?
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Misperceptions about their safety. Medications are prescribed
by doctors, many assume its safe to take under any circumstances.
Increasing environmental availability. Between 1991 and 2010,
prescriptions for stimulants increased from 5 million to nearly 45
million and for opioid analgesics from about 75.5 million to 209.5
million. Varied motives for their use. Underlying reasons include:
to get high; to counter anxiety, pain, or sleep problems; or to
enhance cognition. Whatever the motivation, prescription drug abuse
comes with serious risks. Why?
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Addiction is a medically recognized Brain Disease Not a moral
failing Not related to your relationship with God Strong genetic
component Why?
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Many become addicted due to real pain issues and get cut off by
prescribing MD, then turn to street drugs. Opiates deplete the
bodys supply of endorphins - our natural pain management system.
Use to block the pain, then use to avoid withdrawal, and then use
just to feel normal. Most users quickly switch to heroin because of
the lower price. Why?
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Many local and leading company have made changes CVS Pharmacy
are banning some MDs. CVS Pharmacy are banning some MDs. Milwaukee
County E.R.s agreement Milwaukee County E.R.s agreement Treatment
providers can go through T19 reviewer and request a pharmacy
history or a Lock-in Suboxone prescribers must first go through
specialized training and have limits the first few years
Response
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Unexplained financial problems Scabs, bruises Relationship /
work / school problems Poor Hygiene Unclean household Complaints of
constipation, muscle aches Sedation Symptoms
1 Cold Turkey - rarely successful on own - rarely successful on
own 2 Medically Monitored, medicates for W/D symptoms medicates for
W/D symptoms 3 Medically Supervised -Suboxone -Suboxone - Short
term use in detox - Short term use in detox - longer term use,
Outpatient - longer term use, Outpatient 4 Methadone - requires
strong motivation & support - requires strong motivation &
support Detox
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Buprenorphine (Suboxone / Zubsolv) Methadone Naltrexone /
Vivitrol Medications for Drug Addiction
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Approved for use since 2002 MD must go through training before
able to prescribe, limits on number of clients Mixture of
burprenorphine and naloxone (opiate agonist & antagonist)
(opiate agonist & antagonist) One stops withdrawal / cravings
and the other prevents euphoria Suboxone
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Increased ability to treat addicts outpatient allows for
continuation in daily routine Stops withdrawal and blocks cravings
Danger of overdose Still requires a taper before stopping Comes in
single dose packets Never should be over 16mg / day Suboxone
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Opiate antagonist Parent drug is Narcan Blocks cravings &
euphoria Will make you dope sick if use street drugs Also comes in
injectable form but may be costly Works on alcohol too Must be
opiate free for 10 days before use Can interact with some OTC cold
medications Naltrexone
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Oldest substitution for opiate addiction Never intended as a
cure / treatment Requires daily visits for first 4 or 5 months
Infrequent therapy Very long taper Methadone
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Wisconsin has exceeded 500 deaths per year, 4 out of the last 5
years ; 512 for 2010 From 2002 to 2010, Mortality rate has
increased 3.8% From 2006 to 2011, newly reported cases of Hepatitis
C have increased 13% State Drug Related Deaths
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2005 to 2010 Heroin deaths - increased by more than 50% Opiates
related deaths - increased 33% Benzodiazepines - increased 60%
Cocaine - down over 50% State Drug Related Deaths
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From 2002 to 2010 the cost to provide treatment has risen 126%
to 287 million dollars risen 126% to 287 million dollars From 2006
to 2010, the number of people seeking treatment with public funds,
dropped 14% From 2002 to 2008, the amount of funds spent by the
state on treatment decreased 12% 92 million to 75 million 92
million to 75 million Treatment
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Components of Comprehensive Drug Addiction Treatment
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No single treatment is appropriate for all individuals
Effective treatment attends to multiple needs of the individual,
not just his/her drug use Treatment must address medical,
psychological, social, vocational, and legal problems Matching
Patients to Individual Needs
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Depends on patient problems/needs Less than 90 days is of
limited/no effectiveness for residential/outpatient setting A
minimum of 12 months is required for methadone maintenance Longer
treatment is often indicated Duration of Treatment
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Detoxification safely manages the physical symptoms of
withdrawal Only first stage of addiction treatment Alone, does
little to change long-term drug use Medical Detoxification
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Effective treatment need not be voluntary Sanctions/enticements
(family, employer, criminal justice system) can increase treatment
entry/retention Treatment outcomes are similar for those who enter
treatment under legal pressure vs voluntary Motivation to Enter/
Sustain Treatment
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Goal of treatment is to return to productive functioning
Treatment reduces crime by 40-60% Treatment increases employment
prospects by 40% Drug treatment is as successful as treatment of
diabetes, asthma, and hypertension Effectiveness of Treatment
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Complements and extends treatment efforts Most commonly used
models include 12-Step (AA, NA) Most treatment programs encourage
self-help participation during/after treatment Self-Help and Drug
Addiction Treatment
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Treatment is less expensive than not treating or incarceration
(1 yr methadone maintenance = $4,700 vs. $18,400 for imprisonment)
Every $1 invested in treatment yields up to $7 in reduced
crime-related costs Savings can exceed costs by 12:1 when health
care costs are included Reduced interpersonal conflicts Improved
workplace productivity Fewer drug-related accidents
Cost-Effectiveness of Drug Treatment
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Drug treatment is disease prevention Drug treatment reduces
likelihood of HIV infection by 6 fold in injecting drug users Drug
treatment presents opportunities for screening, counseling, and
referral HIV/AIDS, Hepatitis and Other Infectious Diseases
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Bridge to Action...Communities Coming Together Bridge to
Action...Communities Coming Together