Opioid Epidemic

Question 1

Opiate

Answer 1

Alkaloid found in the opium poppy (Papaver somniferum),

includes: morphine, codeine, noscapin, papaverine, and thebaine

Question 2

Opiods

Answer 2

broad class

• opiates
• Semi-synthetic derivates of opiates
• synthetic drug

Question 3

Semi-synthetic derivatives of opiates

Answer 3

morphine, heroin, thenaine, oxycodone, buprenorphoine, naltrexone

Question 4

Synthetic drug

Answer 4

having similar mechanism of action as an opiate

methadone or fentanyl

Question 5

Highest substance abuse in 2018, people age 12 or order

Answer 5

Alcohol (#1)

Tabacco (#2)

Alcohol (AUD) and illicit drug use disorder (IDUD) often overlap

Question 6

People excluded from surveys

Answer 6

no fixed address (homeless, not in shelter)

institutionalized (incarcerated)

military personnel

Question 7

Undertreating Pain may subject physicians to professional disciplinary

Answer 7

• Federation of state medical boards of the united states
  
  • recognizes that undertreatment of pain is a public health priority
  • has recommended a revision of model guidlines for all medical boards starting that undertreatment of pain is a practive violation
• State medical boards of california and oregon have alread disciplined doctors for undertreating

Question 8

Emergence of two beliefs

Answer 8

opioids dont cause addiction when used to treat pain

pain is undertreated

Question 9

Race and opiod use disorder

Answer 9

whites more

• 2015-2017: blacks in large central metro areas experience the largest increases in rates of opiod overdose deaths
• Highest opioid overdose death rates and largest increase among older black males
• 47% lower OUD treatment rates for blacks compared to whites (2005-2013

Question 10

Who ohas the fastest rate of increase in mortality from opioids

Answer 10

D.C

more than tripling every year since 2013 and a high mortality rate from synthetic opioids in 2016; the mortality rate from natural and semisynthetic opiods was 6.9 per 100,000

Question 11

Despite the need, blacks much less likely to recieve ________

Answer 11

buprenorphine MAT

Question 12

When was the last opiod epidemic

Answer 12

Late 19th century

opioids promoted as safe and effective for common chronic conditions

Question 13

How do drug epudemics spread?

Answer 13

Social contagion within communities

Question 14

Social contagion

Answer 14

• specific person-to-person routes of transmission “spreaders”; circumstances surrounding initiation, polydrug using friendship groups
• multiple sources of spread in a community
• microepidemics (small clusters of cases in an area) can occur anywhere
• Macroepidemics: (large clusters in an area or community) generally occur in commuities that have undergone rapid population change, bleak economic prospects, breakdown in community stability and mechanism of social control

Question 15

Why do people become addicted?

Answer 15

The drug and its effect

the setting

indivdual vulnerability (Genetic, situational, psychological/emotional)

Question 16

Primary prevention

Answer 16

Decrease opiod overprescribing

• education advisory to physicians, other health care providers, and the general public
• increased restrictions of prescribing and discpensing
• Changes in guideline and treatment reccomendations” PDMP, urine toxicology monitoring, lower doses
• Introduction of abuse deterrent formulations

Question 17

Turn the tide: The Surgeon General’s Call to end the opioid crisis

Answer 17

2016 Dear Colleague letter

Take the pledge

2018 National advisory

Question 18

Professionals pledge to

Answer 18

1. Educate themselves to treat pain safely and effectively
2. screen our patients for opiod use disorder and provide or connect them with eveidence-based treatment
3. talk about and treat addiction as a chronic illness, not a moral failing

Question 19

Before Prescribing

Answer 19

Assess pain and function

consider if non-opiod therapies are appropriate

talk to patients about treatment plan

evaluate risk of harm or misuse checl

Question 20

When prescribes

Answer 20

Start low and go slow

Question 21

NAtional History of heroin addicition

Answer 21

• 33 year follow up of patients treated in CAP: 48% died; deaths mainly due to opiod use disorder
• Persistence of heroin use after onset addiction
  
  • Very few (<20%) achieve long term abstinence
  • 1/6 of those using at 20 year follow up were abstinent 10 years laters
  • 1/6 of those abstinent for <5years ar 20-year follow up were abstinent 10 years later
  • High relapse even after longer long-term abstinence: 1/4 of those abstinent >15 years relapsed over the next 10 years

Question 22

continued increase in overdose deaths despite substantially reduced opiod prescribing

Question 23

Primary prevention

Answer 23

Changes in opiod prescribing practives reduce the incidence of misuse (but those already addicted shift to more dangerous drugs and routes of administration

Question 24

Secondary prevention

Answer 24

Early identification of misuse or addiciton (through routine monitoring of indicators of misuse among those prescibed opioid or routine screening for OUD in medical settings) and intervention;

opioid overdose education and naloxone distribution

Question 25

Tertiary prevention

Answer 25

Treatment with methadone, buprenorphine, or extended-release injection naltrexone is effective, reduced overdose and HIV and HCV transmission risk, but underutilized