Presentation on theme: "Primary Care Drug Diversion: Psych co-morbidities in teenage patients with addictions and opioid dependence."— Presentation transcript:
Primary Care Drug Diversion: Psych co-morbidities in teenage patients with addictions and opioid dependence
Primary Care Drug Diversion: Emergency Department CME Meeting Minimizing Opiates in the Medicine Cabinet
William Morrone DO, ASAM, ACOFP, DAAPM Medical Director, Hospice of Michigan CT 101 Consulting Liaison Wolverine Human Services Assistant Director of Family Synergy Medical Education Alliance MSU - CHM
Ethical speakers are required to give: CREDENTIALS A NEEDS STATEMENT FINANCIAL DISCLOSURES CONFLICTS OF INTEREST PURPOSE OF CURRICULUM A RISK DISCLOSURE CITATION GOALS
Who is speaking? ACOFP board certified primary care physician Family Medicine educator (Synergy Medical) Joint appointment to Dept. of Psychiatry Credentials in Pain and Addiction Credentials in Forensics/Deputy Med Examiner Armed Forces Institute of Pathology Masters Tox/Pharm U. Missouri at KC/Pharm Active pain consultant & Hospice Director Activist, advocate & addictionologist
Needs statement 8
$$ Disclosures $$ Lawyers DMC MHPCO MOA MAOFP MAFP (MSMS) MSU-SCS AOAAM/AOA HealthPlus Memorial Healthcare MidMichigan Medical Center
11 This curriculum includes the core information for the evaluation of patient risk for opioids. Treatment decisions should be made based upon the individual patient, the level of risk and available resources to reduce diversion. The standard of care constantly evolves and this lecture will review the current status. Physicians who use opioids are responsible for their own decisions. Dr. Morrone does not assume any patient care responsibilities. Purpose of this curriculum and disclaimer
Upon completion of this course participants will be able to: 1) Describe the prevalence of the illicit use of prescription drugs by Midland County youth. 2) Discuss the causes of the increase in illicit use of prescription drugs by Midland County youth. 3) List strategies to reduce and prevent youth from obtaining illicit prescription drugs.
Target of Change Issues Teenagers at schools were drugs are used, sold and kept are more likely to use. Illegality of drugs deters use. CASA 2005 drug survey, ( C enter on A ddiction and S ubstance A buse at Columbia University) “High stress, frequent boredom and too much spending money are a catastrophic combination for many American teens,” said CASA Chairman and President and former U.S. Secretary of Health, Education and Welfare Joseph A. Califano, Jr.
Reasons behind drug diversion: # 1 undiagnosed psychiatric co-morbidity # 2 peer non-medical use of prescription # 3 drug access has too few barriers # 4 reluctance to monitor UDS, MAPS etc… # 5 unknown resources to help recovery # 6 inherit drug diverting teen from other PCP # 7 Parents are involved in diversion & misuse # 8 Parents are not involved in teen’s life # 9 teen insulated from criminal consequences
Rule CHANGES in our model MAPS use to identify patients/parents at risk. Target parents taking Norco, Valium and Soma. UDS the teens at risk. Operation Medicine Cabinet programs (OMC). Psychiatric screen teens for stress and ASPD. Naloxone in home and high risk environments. Public school programs involving parents. Look for intoxication and withdrawal in teens.
What is drug diversion?
Ten Sixteen webpage People come to Ten Sixteen Recovery Network with life stories that don't match their dreams. Hope has been lost. The staff at Ten Sixteen is here to help change that story. It starts with trust. We listen. We don't make judgements. We build a partnership. We show the client this isn't how the story has to go after all. Life has possibilities. Through gut-wrenching honesty and hard work, they can free themselves from the past. They can find joy in a new way of living. Our goal is far more than abstinence. It is about changing the whole person. Living with honesty and integrity. Being responsible. Developing a new vision for the future. Creating a plan to make that real. Finding the spirit to keep going. Finally free. Finally Strong. They have found where they belong, equipped to change their story. Hope is restored.
Ten Sixteen inpatient drug use Alcohol47 % Marijuana6 % Cocaine/crack 12 % Rx34 %
DIGFAST on the radar? D istractible I ndiscretion G randiosity F light of ideas A ctivity increase S leep problems T alkative
Get your own web copy.
Narcotic CRIME trends Midland % Midland % INCREASE of 36 % Third District % Third District % INCREASE of 20 %
Options and Examples TEN Sixteen Network Dr. Rene Thomas-Clark pediatric psychiatrist Recovery Pathways, LLC licensed treatment Dr. Doug Foster, addiction psychiatrist (AAAP) Wolverine voluntary Vassar boot camp White Pine psychiatric inpatient residential Vista Maria psychiatric inpatient residential BRMC psychiatric inpatient mental health Dr. Dale D’Mello inpatient St. Lawrence MSU
Recovery Pathways Kim Debelak Executive Director Contract Counseling, Education, Mental Health & Substance Abuse Resources
Recovery Pathways, LLC 717 East Midland Street, Bay City, MI (989) business office (989) fax Kim Debelak, Executive Director
Special problems to teenagers Teenagers see themselves as indestructible. Without juvenile justice they’re not motivated. Faulty thinking and poor judgment remain. Parents insulate and protect bad behaviors. Peer pressure and friends don’t change enough. Medicalization and CBT are expensive and slow. Primary care doesn’t have the time.
You should be drug testing everyone. When teens are in trouble at school. When teens are lying and they get violent. When teens have friends change. When teens don’t come home. Annual physical or sports physical. When teens are hiding cigarettes and alcohol. “You can’t prevent it, if you don’t monitor it.” PUBH-6145: Epidemiology, Walden University MPH
Upon completion of this lecture participants will be able to: 1) Describe the prevalence of the illicit use of prescription drugs by Midland County youth. 2) Discuss the causes of the increase in illicit use of prescription drugs by Midland County youth. 3) List strategies to reduce and prevent youth from obtaining illicit prescription drugs.
Summary of Change Issues Teenagers at schools were drugs are used, sold and kept are more likely to use. Illegality of drugs deters use. CASA 2005 drug survey, ( C enter on A ddiction and S ubstance A buse at Columbia University) “High stress, frequent boredom and too much spending money are a catastrophic combination for many American teens,” said CASA Chairman and President and former U.S. Secretary of Health, Education and Welfare Joseph A. Califano, Jr.