Reducing Negative opioid Outcomes-Prevention and Treatment

What you need to know to help others

WHY WE ARE HEREWhat ’s Happen ing Nat iona l ly

WHY WE ARE HEREW hat ’s H appen ing in O k lahom a

Prescription drug abuse is Oklahoma’s fastest

growing substance abuse problem.

§ Nearly 3,900 unintentional poisoning deaths

from 2007-2012

§ Four out of five deaths involved at least one

prescription drug

§ Drug overdose is now the leading cause of

injury death in the United States.

§ Oklahoma ranks among the highest in the

nation for unintentional poisoning deaths

Drug Deaths

In2016therewere759unintentional

poisonings:

• 67%involvedprescriptiondrugs

• 64%involvedanopioid

• 18%involvedabenzodiazepine

• 8%involvedanantidepressant

• 5%involvedamusclerelaxant

• Allprescriptiondrugsinvolvedin

overdosedeathsareoriginally

prescribedforpainoramental

healthcondition.

Opioids(painkillers),64%

Benzodiazepines,18%

Antidepressants,8%

MuscleRelaxants,5%

PrescriptionDrugsInvolvedInUnintentionalPoisoning

Deaths

Source:OSDHInjuryPreventionService,FatalUnintentionalPoisoningSurveillanceSystem

WHY WE ARE HEREWhat ’s Happen ing in Ok lahoma

Prevention

• Regional Prevention Coordinators• Community Coalitions• Overdose Education and Naloxone

Distribution (OEND)• First Responder Naloxone• First Responder OEND pilot• Practice Facilitation

Treatment

• Medication Assisted Treatment (MAT)• Increasing access to treatment• Increasing number of Data 2000

Waivered physicians• Increasing access to recovery

services

PatientEducation

COMMON OPIOIDSKnow W ha t to Look fo r

Opioids are highly addictive narcotic substances

commonly prescribed to treat pain. These are some of

the most commonly prescribed opioids:

§ Codeine

§ Fentanyl

§ Hydrocodone/Acetaminophen

§ Hydromorphone

§ Morphine

§ Methadone

§ Meperidine

§ Oxycodone

§ Tramadol

OPIOID RISKS

Prescription opioids carry serious risks of addiction

and overdose, especially with prolonged use. The use

of prescription opioids can have a number of side

effects as well, even when taken as directed:

§ Tolerance – needing to take more of a medication

for the same pain relief

§ Physical dependence – meaning you have

symptoms of withdrawal when a medication is

stopped

§ Increased sensitivity to pain

KNOW WHO IS AT RISKPrescription drug abuse doesn’t discriminate.

Opioids may be abused by anyone, though some

individuals may face an elevated risk:

§ Repeated use of opioids greatly increases the

risk of developing an opioid use disorder.

§ The use of illegal opiate drugs such as heroin.

§ Anyone with a history of drug misuse or

addiction.

PREVENTIONG et t ing Ahead o f the Ep idem ic

§ Never share or use another person’s

opioids

§ Safeguard meds — keep opioid

medications locked away

§ Talk early and often with family

members about opioid-related dangers

Oklahoma’s Prescription for Change starts with you. Make sure all members of

your household know what to do when someone is prescribed opioids.

§ Practice healthy coping

§ Carry Naloxone in your household’s

first aid kit

§ Teach others in your community what

you’ve learned to do to prevent opioid

abuse

WHAT PATIENTS CAN DOD r ive C onve rsa t ion w i th You r Phys ic ian

Patients can take control of their health care decisions.

If your physician suggests opioids, ask:

§ Why do I need this medication — is it

right for me?

§ How long should I take this medication?

§ Are there non-opioid treatment options

that could help with pain relief?

§ How can I reduce the risk of potential

side effects with this medication?

§ Could this treatment interact with my other

medications?

§ What if I have a history of addiction with

tobacco, alcohol or other drugs?

§ What if there’s a family history of addiction?

§ How should I store this medication?

§ What should I do with unused medication?

§ Do you offer Naloxone?

IF YOU ARE PRESCRIPED OPIOIDS

Follow these safety measures if opioids are prescribed:

§ Don’t mix with alcohol, benzodiazepines (such as Xanax or Valium), muscle

relaxants (such as Soma or Flexeril) or hypnotics (such as Ambien or Lunesta)

§ Store them securely, monitor the supply and dispose of them safely

§ Never share medication

§ Never take greater amounts than prescribed

§ Get a Naloxone kit for your household

HARM REDUCTION

WHAT IS HARM REDUCTION?

Harmreductionisasetofpractical

strategiesandideasaimedatreducing

negativeconsequencesassociatedwith

druguse.

HarmReductionisalsoamovementfor

socialjusticebuiltonabeliefin,and

respectfor,therightsofpeoplewhouse

drugs.

OPIOID HARM REDUCTION STRATEGIES: AGE AND HEALTH

Yourageandphysicalhealtharegoingto

impactyourbody’sabilitytomanage

drugs.Olderpeopleand/orthosewith

longerdrugusingcareersareatincreased

riskforfataloverdose.

Dehydration,noteatingorsleepingalso

increasesriskforoverdose.

Harm Reduction Strategies:

§ Drink water and try to eat before using

§ Avoid anything with Tylenol in it (like

Percocet) if you have liver problems

§ Go slow if you’ve been sick, lost weight,

or weak.

§ If injecting heroin, do a test shot

§ Get a regular checkup to test for other

risk factors.

§ Carry Naloxone in case of overdose

OPIOID HARM REDUCTION STRATEGIES: DON’T MIX DRUGS

Mostoverdosesaretheresultofmixing

opioidswithotherdrugs,especially

alcohol,Xanax,orSoma.

Speedballing (mixingopioidsanda

stimulantsuchascocaineormeth)also

increasesrisk.

Harm Reduction Strategies:

§ Use one drug at a time

§ Use less of both drugs

§ Always avoid mixing illicit opioids

(anything not from a pharmacy) and

alcohol.

§ Have a friend with you who knows what

you have taken and will call for help.

§ Carry Naloxone in case of overdose

OPIOID HARM REDUCTION STRATEGIES: TOLERANCE

Toleranceisthebody’sabilitytoprocessa

certainamountofadrug.Tolerance

increaseswithopioiduse.

Tolerancecandecreaserapidlywhen

someonehastakenabreakfromusinga

drugwhetherintentionally – forexample,

whileindrugtreatmentoronmethadone

detox– orunintentionally– forexample,

whileinjailorthehospital.

Harm Reduction Strategies:

§ Use less if you haven’t used, or used

less for a few days.

§ Be careful, go slow

§ Use a different method (snort rather

than inject)

§ If injecting heroin, do a test shot

§ Have a friend with you who knows what

you have taken and will call for help.

§ Carry Naloxone in case of overdose

OPIOID HARM REDUCTION STRATEGIES: QUALITY

Qualityisthepurityand/orstrengthofa

drug.

Thecontentofstreet/illicitdrugsisalways

unpredictable. Drugscanbedifferentthan

advertised(fentanylinsteadofheroin),or

producedincorrectly.

Harm Reduction Strategies:

§ Test the strength before you use the

whole amount.

§ Know who you are buying from.

§ Know the pills you are taking

§ Don’t trust pills are what they look like,

fake pills are out there.

§ Have a friend with you who knows what

you have taken and will call for help.

§ Carry Naloxone in case of overdose

OPIOID HARM REDUCTION STRATEGIES: USING ALONE

Usingaloneincreasestheriskoffatal

overdosebecausethereisnoonetocall

forhelporadministernaloxone.

Harm Reduction Strategies:

§ Don’t use alone

§ Call or text a friend who can check on

you if they haven’t heard from you

§ Leave your door unlocked

§ Carry Naloxone in case of overdose

Opioid Overdose

OVERDOSE

OVERDOSE RISK

Overdose risk increases for many reasons

including:

§ having liver, kidney, or breathing problems

§ taking opioids with benzodiazepines such as

Xanax, muscle relaxers, or alcohol.

§ taking more pills or more often than prescribed

§ any change in tolerance, especially if you don't

use or use less for a short period of time

§ changes in quality or purity of street drugs,

including fake pills

§ For users who attempt to achieve abstinence from drugs,

the average time from first treatment to last use is 9 years

with multiple episodes of care.§ Overdose risk is high during these periods of abstinence.

§ Naloxone is a drug used to reverse the effects of opioids.

§ Naloxone is safe and effective.

§ Naloxone has no effect on non-opioid overdoses.

Overdose Prevention : Naloxone

OVERDOSE EDUCATION AND NALOXONE DISTRIBUTION

In the United States:

§ Over 640 naloxone programs

§ Over 150,000 people trained

§ Over 25,000 overdose

reversals (lives saved)

SIGNS OF AN OPIOID OVERDOSE

Respond to an overdose:

Stimulate &Alert 911

1.Stimulate victim with a sternal rub

2. If no response, delirious, or altered consciousness, call for 911 support

Peel

Place

Press

How to Give Narcan

Nasal Spray

Recovery Position After Narcan is Given

GET NALOXONE

WHERE TO FIND NALOXONE

WHERE TO FIND NALOXONE

okimready.org/overdose/

WHAT HAPPENS AT A HUB?

§ Informational survey (no identifying information)

§ Brief (10 min) education

§ Recognize overdose

§ Respond to overdose

§ Prevent overdose

§ Get a kit

OPIOID OVERDOSEKnow H ow to Ac t

Recognize

§ Won’t respond to noise or

light

§ Slow or no breathing

§ Bluish lips and/or fingertips

§ Pinned pupils

Respond

§ Stimulate by calling their

name or gently shaking them

§ Call 911

§ Administer Naloxone if

available

§ Perform CPR

§ If no response in 3-5

minutes, administer

Naloxone again

Prevent

§ Avoid

§ Only take if prescribed to you

§ Don’t take opioids with other

drugs

§ Don’t take more than

prescribed

§ Dispose safely

WHAT ELSE HAPPENS AT A HUB?

All:

§ Medication Assisted Treatment (MAT)

Many:

§ Recovery Services

§ Other drug and alcohol treatment

§ Mental healthcare services

WHAT HEALTH CARE PROVIDERS CAN DO

§ Work together with patients on a plan to

manage their pain

§ Use non-opioid treatments

§ Use multimodal approaches

§ Focus on patient’s functional, realistic goals

§ Review patient PMP records prior to and

frequently after prescribing

§ If initiating opioid therapy, use short-acting

opioids

§ Identify risk of harm and offer treatment for

opioid use disorder

§ Educate patients on risks of opioid abuse

§ Use informed consent agreements with

patients

§ Understand the guidelines for pain

management

§ Complete continuing medical education in pain

management

§ Enroll in dissemination programs to implement

evidence-based clinical guidelines for pain

management in your practice

MEDICATION-ASSISTED TREATMENTApproach ing Pos i t i ve O p io id Abuse Trea tm en t

§ Is primarily used for treatment of

addiction to opioids

§ The prescribed medications block

euphoric effects of opioids, relieve

cravings and normalize body functions

Medication-Assisted Treatment (MAT) combines the use of medications with

counseling and behavioral therapies to provide a “whole patient” approach to the

treatment of substance use disorders.

MAT:

§ Medications used in MAT are approved

by the FDA

§ Programs are clinically tailored to each

patient’s needs

§ Should not be used in conjunction with

anxiety medications

ADDITIONAL PROGRAM RESOURCES

Prescription for Change Website okimready.org

What to Ask Your Doctor Before Taking Opioids: A Checklist

Prescription Opioids: What You Need to Know

Why Guidelines for Primary Care

Continuing Medical Education Course

Treatment Center Locations

Oklahoma’s Do No Harm Program

Be Part of the Solution

§ Help prevent and treat the abuse of

prescription drugs in Oklahoma

§ Educate the community about safe use,

storage and disposal

§ Help change Oklahoma’s pattern of drug-

related overdose deaths

WHAT WE CAN DOA P resc r ip t ion fo r C hange in O k lahom a