powerpoint presentation slideshow.pdf · pain treatment 1980s liberal prescribing 1990s users move...
TRANSCRIPT
![Page 1: PowerPoint Presentation Slideshow.pdf · Pain treatment 1980s Liberal prescribing 1990s Users move to Heroin late 1990s Xalisco Boys ... opiates for pain 1990s. 1996. Russell Portenoy,](https://reader034.vdocuments.site/reader034/viewer/2022042909/5f3a240a993f5733fc557ca3/html5/thumbnails/1.jpg)
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Important Distinction
• DEPENDENCE – Adaptation producing withdrawal
• ADDICTION – Chronic progressive brain disease
• Inability to abstain
• Impaired behavioral and emotional control
• Craving
• Diminished recognition of significant problems
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Mexican trafficking
1980sPain
treatment
1980s
Liberal prescribing
1990sUsers
move to Heroin
late 1990s
Xalisco Boys go north &
east
late 1990s
OD deaths rise 16x in
WA
1995-2004Evolution
of an Epidemic
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Mexican trafficking
begins in LA
1980s
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Changes in medical pain management
1980s
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Jane Porter and Hershel Jick, MDNew England Journal of Medicine, January 1980 Letter to the Editor
• Only 4 of 11,882 hospitalized patient records developed an addiction to opiates.
• 1-paragraph letter became evidence that opiates cause less than “1 percent addiction”
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Arthur Sackler, MD
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Russell Portenoy, MD
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Liberal prescribing of
opiates for pain
1990s
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1996
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Russell Portenoy, MD
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Dr. David Procter’s mansion Portsmouth, Ohio
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Prescription users move to
Heroin
late 1990s
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Heroin: 1/10 gm (100mg) = $10Rx Opiate: 1/10 gm (100 mg) = $100
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Xalisco Boys go north & east
Late 1990s
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Opioid Overdose Deaths
1995 - 24 2004 - 386
A 16-fold increase
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OxyContin Sales
2000 - $1 Billion2010 - $3 Billion2014 - $2.5 Billion
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The Structure
I “Pieces of the puzzle”
IV “Out of the closet”
V “Hope for the future”
II “Puzzle comes together”
III “Picture is not pretty”
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Critical Reviews
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