Lecture 14 Flashcards
Which of the following is not an opioid?
A) Heroin
B) Oxycodone
C) Codeine
D) Mescaline
D
define psychoactive substances
- alter our consciousness perceptions and mood
What are the categories of psychoactive substances?
- Depressants
- Stimulants
- Hallucinogens
- Opioids
describe depressants
- Rx for anxiety, insomnia, seizures
- Decreases CNS and heart rate
- Decreases processing and coordination
- inhibitions (a feeling that makes one self-conscious and unable to act in a relaxed and natural way)
describe stimulants
- energy
- alert
- jittery
- increase heart rate
describe hallucinogens
- a psychedelic
- perceptual changes
describe opioids
Rx pain
- decrease CNS
- breathing
What are examples of depressants?
- barbiturates
- benzodiazepines
- alcohol
What are examples of stimulants
- coffee/caffeine
- cigarettes/nicotine
- amphetamines/meth
- ecstasy/MDMA/Molly
What are examples of hallucinogens?
- LSD
- psilocybin (magic mushrooms)
What are examples of opioids?
- oxycodone
- hydromorphone
- morphine
- methadone
- heroin
- fentanyl
Why do people use psychoactive substances (4 things and extras)?
- Cultural reasons/traditional ceremonies
- self-medicate to:
— feel better; treat anxiety, stress, depression, isolation, numb emotional/Psychol pain or trauma
— do better; improve performance, Rx ADHD
— feel good; feelings of pleasure
— survival - homeless, lack of $$ - curiosity/to fit in:
— experiment, build connections, peer pressure - avoid withdrawal
— developed a physical dependency
— physician over-prescribing
Who introduced OxyContin? When was it introduced and what is it?
- Purdue Pharma
- in 2000
- a long-acting opioid and promoted it
— Pain was underrated
— OxyContin was safe and non-addictive
What happened to OxyContin?
- Rx increased, diversion, crushed and snorted or injected
In 2012, OxyContin patent ended. What did Purdue introduced?
- OxyNeo was introduced
- tamper proof version
- if crushed, became jelly-like, so can’t be snorted or injected
explain the fall of OxyContin and emergence of fentanyl
2012: OxyContin was delisted in many jurisdictions
2014: fentanyl started appearing in unregulated street market
— powdered fentanyl mixed with or sold as heroin
— fake Oxy’s (green meanies) 2016
Outcome is influenced by reasons for use, resiliency/support and social determinants of health like…?
- poverty
- unemployment
- homelessness
- adverse childhood experiences, physical/sexual abuse
- indigeneity - colonization and racism, etc.
- lack of belonging and connection - made worse by COVID
What are the 4 guidelines to using non-stigmatizing language?
treat all people with the same respect
- use people-first language
— person who uses opioids // opioid user or addict - Use language that reflects the medical nature of substance use disorders
— person experiencing problems with substance use // abuser or junkie - use language that promotes recovery
— person experiencing barriers to accessing services // unmotivated or non-compliant - avoid slang and idioms
— positive test results or negative test results // dirty test results or clean test results
What is the four pillars strategy?
- enforcement
- prevention
- treatment
- harm reduction
- all 4 need to work together
When do pillars not work?
- pillars do not work in isolation. it’t not either one or another
- enforcement encourage people to use more safely (ex. at supervised consumption sites)
- enforcement may test substances and share information to enable accurate reduction/drug alert messages (Drug Overdose & Alert Partnership)
- Engagement in harm reduction can build trusting relationships and lead to treatment
What is enforcement?
criminalizing drug use/prohibition
What is the aim of prohibition?
- put people in prision
— who import, produce, sell (traffic), possess (use) drugs - reduce number of people who use drugs
— make drugs harder to get, increase cost of drugs, make people afraid to use drugs (scare tactic) - make communities safer
How is drug laws based on racism?
- people of colour are overrepresented in US prisons, 2016
Is Canada any better about racism?
- federal prison (2+ years) Indigenous people are 5-6% population, in 2019 - 30% overall corrections population
- BC Corrections Indigenous peoples 35% of those in custody
2022 Indigenous women in both federal and provincial corrections > 50%
In 1920-1933, Alcohol was…?
- widely available (speakeasies)
- stronger - spirits more available than beer or wine (easier to transport smaller volumes
- illicitly produced - contains toxins, no quality control/consistency of content and strength
- controlled by gangs and violent criminals
does prohibition work?
- the price of heroin and cocaine came down despite increased incarceration
- drugs are available in jail
- teens may find it easier to buy illegal drugs than regulated alcohol and tobacco. Don’t need to show ID to buy drugs!
- It’s easy and fast to have illegal drugs delivered to your home - Dial-a-dope
What is the goal of harm reduction?
- aims to keep people safe and minimize death, disease, and injury from high-risk behaviour by promoting safer practices
What are some examples of broader harm reduction?
- accepts risky behaviour will occur but resources/supports to make it safer
- if your drink, don’t drive (safe ride home)
- teen sexual behaviour (birth control pills, condoms)
- driving (car seats, seat belts, airbags)
- working (hard hats, boots)
- sports (protective gear like padding or helmets or goggles, etc.)
What harms are due to illegal drug use?
- infections: (use in unsterile way)
— HIV and HCV
— bacterial from injecting: septicemia, abscess, endocarditis - criminal activities
— organized crime/violence
— individual crimes to fund drug use, B&E, sex work
— drug possession trafficking
— incarceration - overdose events and death
— unregulated supply with unknown potency and constituents
Explain the substance use journey
- addiction is a chronic relapsing issue
- even with treatment it’s not a straight line from dependency to abstinence
- abstinence is not the ultimate goal for many
- everyone has the right to the best possible health
A person who uses drugs …?
- is a human being and deserves to be treated with respect
- is someone’s sister, father, daughter, uncle
- has complex needs
- does not want to have a dependency on substances
- is aware how dangerous drug use is - they have seen their friends and family members die
What does harm reduction do?
- is a philosophy and human rights approach
- treats people with respect
- does not insist on abstinence
- works with prevention, treatment and enforcement - 4 pillars approach
- connects people to services
- meets people where they are
- engages with people who use drugs - nothing about us without us
What does harm reduction do?
- is a philosophy and human rights approach
- treats people with respect
- does not insist on abstinence
- works with prevention, treatment and enforcement - 4 pillars approach
- connects people to services
- meets people where they are
- engages with people who use drugs - nothing about us without us
define abstinence
the practice of restraining oneself from indulging in something, typically alcohol or sex:
What does harm reduction not do?
- mean legalizing drugs
- only provide services (ex. needles or supervised consumption sites)
- prevent people from entering treatment or stopping use
What does harm reduction not do?
- mean legalizing drugs
- only provide services (ex. needles or supervised consumption sites)
- prevent people from entering treatment or stopping use
Someone says “Giving out needles to those addicts promotes drug use and is a waste of tax payers dollars. We need to invest in police not harm reduction to stop the junkies from using it?
How would you respond?
- Language
- can keep people alive
- SUD/addiction not a choice, it’s a health not a criminal issue
- HR does not promote drug use
- treats PWUD as humans
- helps develop relationships, ,by building trust connects people and may lead to treatment
Review one size doesn’t fit all
How do we know what the issues are?
- different needs in different regions, substances used, age groups
- need a range of options
- people with lived and living experience of substance use are the experts in their reality
Review one size doesn’t fit all
How do we know what the issues are?
- different needs in different regions, substances used, age groups
- need a range of options
- people with lived and living experience of substance use are the experts in their reality
- Explain the affect of the engagement of peers and peer workers
- is recognized as best practice in harm reduction
- can lead to nimble/effective OD response & prevention services
- can create “safe spaces” for PWUD & improve program access
- can build connections and trust with shared experiences
What is the HR services in Canada?
- opioid agonist treatment
- Rx alternatives to toxic drug supply (safer supply)
- drug checking services
- HR supplies
- observed consumption sites
- take-home naloxone
What are the drug checking services?
- currently available at SCS & OPS or in person or mail in “Get Your Drugs Tested”
- test strips
— fentanyl fairly sensitive
— Benzodiazepines/Etizolam not so good - various technologies but most point of care give qualitative results (ex. +/-)
What are HR supplies for substance use used for?
- safer injection and safer smoking supplies
What is the observed consumption in BC?
In BC there are:
- 3 supervised consumption sites
- 44 overdose prevention services
— episodic OPS
— peer witnessing
What additional challenges did COVID bring?
- some sites closed, and restricted # visits to enable physical distancing
- people who use drugs may avoid crowds and hence use alone
- drugs initially became more expensive and are more toxic - high level fentanyl, added benzos, etc.
Explain the take-home naloxone
- PWUDs in BC asked why don’t we have naloxone?
- program started August 31, 2012
- initially naloxone was prescription only
- naloxone now unscheduled, available at >2000 community sites at no charge and no identification needed
How does naloxone work?
- Naloxone binds to opioid receptors in the brain
- opioids are forced off
- breathing is restored
- How long does it take for naloxone to work?
- works in 2-5 minutes
how long does naloxone last?
- lasts 20 to 90 minutes
Since August 31, 2012, how many THN kits were shipped?
1.8 million THN kits shipped
Why do we need a range of options in treatment?
Detox and abstinence based treatment
- not suitable for many
- risks if relapse (loss tolerance)
Treatment must be accessible to those who need it, therefore… (the 5 A’s)
Appropriate
- diverse options
Accommodating
- hours of opening
Available
- Equity - rural geography
Acceptable
- no stigma from staff
Affordable
- Low or no cost
- can continue to work
list the prescribed opioid treatment
Methadone - oral
Buprenorphine/naloxone - oral (Suboxone)
Slow release - oral, morphine (Kadian)
Buprenorphine - oral
Hydromorphone (Dilaudid) tablets - oral
Hydromorphine - injection
Diacetylmorphine (heroin) - injection
What is the aim of BC Risk Mitigation Guidance?
- reduce COVID risks, enable people to isolate/quarantine
What were the actions of the BC Risk Mitigation Guidance?
- pharmacy home delivery
- BC nurse prescribing of OAT
- Expansion of treatment options
— Hydromorph/Dilaudid - oral
— Slow release oral morphine (Kadian)
— Sustained release oral morphine (M-Eslon)
— iOAT, TiOAT (Dilaudid)
