Heroin/Pain Pill (Opioid) Addiction

Mary Kirkwood, MD, PsychiatristBoard Certified: Psychiatry &

Addiction MedicineAgnesian HealthCare

Heroin/Pain Pills = OpioidsWhat are Opioids?

Medication/substances that bind to the mu opioid receptor in the brain.

People experience less pain, but may also experience euphoria, sedation, nausea and impaired decision making. Too much opioid can cause

someone to stop breathing and die.Examples: hydrocodone (Vicodin),

oxycodone (Percocet), morphine, codeine, fentanyl, heroin

Symptoms of Opioid AddictionTolerance and withdrawalInability to cut down/control useMuch time spent using/obtaining/recovering

from opioidsStrong craving to use opioidsInability to attend to responsibilities at

school/work/homeUse in dangerous situations (driving)

Severity of Opioid AddictionMild: Two to three symptomsModerate: Four to five symptomsSevere: Six or more symptoms

Heroin/Pain Pill AddictionHow does it start?Complicated or multiple surgeries, or for chronic

pain syndromes. Others are offered pain pills at parties to get high.After using the pills on a chronic basis, patients

get ill from withdrawal when they don’t have pills.

Patients can’t function at work or with their families when they are so sick, so they look for pain pills wherever they can get them.

Heroin/Pain Pill AddictionPost Acute WithdrawalPsychological withdrawal symptoms

that last for up to two years, including irritability, anxiety, tiredness, poor concentration and disturbed sleep.

This makes quitting opiates/heroin very difficult. The temptation to take heroin/pain pills again to relieve these symptoms is hard to resist.

Why Heroin?Doctors are prescribing fewer pain pills because of addiction risk.

Pain pills are more expensive and harder to find in the community.

People in withdrawal are turning to heroin because it is cheaper and easier to find.

Heroin/Pain Pill Addiction

What is the best way to help?MedicationCounselingFamily/friend support

Heroin/Pain Pill AddictionMedication Assisted TreatmentOpioid Replacement = Suboxone and

MethadoneOpioids specifically designed to treat addiction to

help control withdrawal and cravings. Non-opioid replacement = Naltrexone

Helps with cravings, but not withdrawal. Lower success rate than suboxone/methadone.

Heroin/Pain Pill AddictionSuboxone versus MethadoneBoth eliminate withdrawalBoth control cravingsSuboxone: patients rarely develop tolerance Can be prescribed 30 days at a time

Methadone: tolerance is commonRequires daily dispensing at special clinic

Which Works Best?Both suboxone and methadone decrease risk of relapse.

Methadone has a slightly higher retention rate.

Naltrexone also decreases the risk of relapse, but more people drop out of treatment on naltrexone versus suboxone and methadone.

Which Is Safest?Methadone has a higher rate of lethal overdose than suboxone.

Suboxone is less likely to be injected.Naltrexone is the safest of all since there is no overdose risk.

Heroin/Pain Pill AddictionCounselingMedication alone is not enough. Individual

and group counseling help patients learn how to cope in everyday life without drugs.

Family SupportFamily/friends can help by understanding the

need for intensive treatment, which in most cases includes medication.

Pregnant PatientsThe most recommended treatment is suboxone or

methadone.On these medications, women have lower relapse

rates, attend more prenatal visits, and can provide a more stable home life for their baby.

Attempting to detox a woman completely from opioids increases the risk of miscarriage…suboxone and methadone decrease that risk.

OverdoseDeath is by respiratory failure - they stop

breathing.Between 2006 and 2011, there were no deaths

by suspected overdose in Fond du Lac.2012 = 1 death2013 = 4 deathsThe number one cause of accidental death in

the United States is due to poisonings/ overdoses (most commonly opiates).

2014 = 3 deaths2015 = 12 deaths

People Are DyingDeaths by opioid overdoses tripled from between 1999 and 2013.

Between 2010 and 2013 opioid pain pill deaths stabilized, but heroin opioid deaths increased by 37 percent per year.

Risk Factors for OverdoseOpioids plus sedatives and/or alcoholRecent abstinence: results in decreased tolerance

Use of illegal opioids, especially when injected

Lung disease/sleep apnea

What is Narcan?Narcan is a medication that rapidly reverses the effects of opioid overdose.

Comes in a shot form and a nasal spray.Communities that distribute Narcan have lower rates of death by opioid overdose.

Can be given by people in the community when an overdose is suspected.

Signs of an OverdoseThe person is non responsiveThe person isn’t breathing or doesn’t have a pulse

The person has a blue cast to lips or fingertips

Small pupils

Narcan to Prevent OverdoseWho is a candidate for a Narcan prescription?Anyone diagnosed with opioid addictionAnyone receiving or stopping medication

treatment with methadone or suboxoneAnyone at risk of decreased tolerance,

including people released from jail who have a history of opioid addiction

Family or friends of an individual with any of the above characteristics

Narcan AvailabilityAvailable by prescription as injection and nasal

spray at most pharmaciesAgnesian pharmacies have Narcan available by

prescription; hope to have over-the-counter soon

This Is a National EpidemicPresident Obama participated in the National

Rx Drug Abuse and Heroin Summit in Atlanta, GeorgiaIncrease the patient limit for doctors who prescribe

suboxone from 100 to 200Increase in funding

Underserved communities For the distribution of Narcan Investigate the distribution of pills/heroin Provide clean syringes to IV drug users to decrease

risk of HIV/hepatitis

Help at National LevelMedicare, Medicaid and Marketplace

insurance plans will be required to increase access to opioid addiction treatment.

The Center for Disease Control and Prevention has issued guidelines to primary care providers.

Black box warning for fast acting opioids, warning about the risks of abuse, addiction and overdose death.

Addiction Treatment at St. Agnes Hospital

Call (920) 926-4200 to schedule an addiction assessment.

Most patients attend our day treatment program, which lasts anywhere from two to five days, from 8 a.m. to 4 p.m.

During day treatment, most patients are started on suboxone and participate in groups on education about addiction and coping skills.

Addiction Treatment at St. Agnes Hospital, cont.

After day treatment, the patient participates in individual counseling, group counseling, and sees a psychiatrist for the suboxone.

Patients are encouraged to attend Narcotics Anonymous and get a sponsor.

Treatment with suboxone can last for as long as the patient needs it.

Patients successfully weaned from suboxone are encouraged to continue with Narcotics Anonymous (NA) and individual counseling.

Addiction Treatment at St. Agnes Hospital, cont.

Naltrexone (medicine that helps with cravings but isn’t an opiate) is also available to patients.

Treatment for depression, anxiety and other mental health issues.

ResourcesTo find information about opioid addiction

treatment outside of Agnesian HealthCare: http://www.methadoneclinicusa.com http://dpt2.samhsa.gov/treatment/directory.aspx

http://www.suboxone.com/treatment-plan/find-a-doctor

http://www.buprenorphine-doctors.com/find-a-doctor.cfm

Kellie

Before Addiction Childhood Loving family Good grades

High School New friends Experimentation Maintained good

grades

Progression of AddictionDesire to use kept increasing

Didn’t understand addiction

Hard to save moneyEmployment suffered to Use Kept

HeroinJustifications Cheaper Easiest to obtain It’s OK as long as I’m not shooting up like

a “junkie” Escalated quickly

Six Months Clean…Relapse

Rock Bottom Arrested June 8, 2014 Serious legal problems Facing possible prison

In jail I found out I was pregnant.

Recovery June 8, 2014 August 2014 - Treatment at St. Agnes

Hospital Behavioral Health Services Actively involved in Narcotics Anonymous

(NA)

Healthy Baby Girl – November 17, 2014

TodayLegal issues resolvedEmployed

Awesome Family Support

Healthy Friends

Sponsor

NARCOTICS ANONYMOUS

I’m Kellie.Recovering addict with 1 year and 11 months clean/sober.

My Life. . . . . . . . . . . . . . . . . . . . . .

Wendy McGurk

The BeginningMy father was an alcoholic

Thought everyone grew up around alcohol/normalHe was an angry drunk

My parents divorced when I was nine Felt very isolatedHad to move Started changing

My mother introduced new husband

AdolescenceStarted drinking at 14

First time I got wastedTried marijuana, cocaineNew group of friendsStopped caring about school and familyVery rebellious/started running awayBy 16, I was drinking every weekend and could

drink eight to 10 beers

Growing PainsBy 17, I had to sit in jail

First thoughts I might have a problemStraightened out, got it together and graduatedFound a job serving tablesAt 18 enrolled in college Struggled to get homework done due to drinkingDropped out after 1-½ years from alcohol use Still serving tables and drinking four to five nights a

week – 12 pack of beer

Stepfather DiesAt age 22, my stepfather died

Was introduced to opiates, painkillersBest feeling ever Was hooked right awayWas using regularly to numb painLost my jobLost my apartmentMoved back home

AddictionCould not stopObsession of the brain/all I thought aboutNobody trusted me anymoreWent from boyfriend to boyfriend to support habitStarted drinking when I did not have pills to avoid

withdrawal Tried to quit and failed Was using around 10 to 15 15mg Percocet dailyThought I was going to die/contemplating suicide

HealingSt. Agnes for help/inpatient programTotally surrendered and was willing to do

anything to get helpStarted suboxone programWithin the first week I felt changes

Obsessive thinking was goneHad clear thoughtsDid not want to take all of my medication Started therapy Gave my life over to the care of God

RecoveryIn the first year of sobriety I got married, had a baby and started school

I graduated from Moraine Park with high honors in December 2014 with my Associates Degree and SAC-IT

Bachelors from Viterbo end of 2016

RecoveryI now have a loving familyI have confidence in myselfI want to give what has been given to meBelieve that addiction is a disease that I need to manage daily

Life CAN change

Thank You!