Understanding the opioid epidemic Brown bag lunch series Framingham public library March 1, 2019 Kelly Joseph, MS Over the past decade, opioid misuse has risen to an epidemic level in the United States. Opioid overdose is now the leading cause of death for those under 50, surpassing motor vehicle accidents and firearms.  Massachusetts has been hit particularly hard, and no community has been immune to the devastating consequences of this public health crisis.   This foundational workshop will provide an overview of the opioid epidemic.  Attendees will gain an understanding of the disease of addiction, how opioids work, the local impact, and learn about the important role that individuals have in helping to reduce the risk of substance misuse in their community.  

Learning objectives Describe the disease of addiction Explain how opioids work Recognize the impact of the epidemic Identify your role in reducing opioid misuse in your community

BEFORE WE BEGIN…

WHAT IS ADDICTION? https://www.youtube.com/watch?v=jrp9qr0yBDU&feature=youtu.be

ADDICTION IS A BRAIN DISEASE LIKE OTHER DISEASES, ADDICTION Characterized by: Compulsive Behavior Continued abuse of drugs despite negative consequences Changes in the brain’s structure and function LIKE OTHER DISEASES, ADDICTION Changes a person’s biology If untreated, can last a lifetime Is preventable Is treatable

The last part of the brain to develop is the prefrontal cortex – controls judgement and decision making This, in part, explains why teens and young adults may exercise poor judgment and risk taking behaviors DELAY USE = lower risk of developing a substance use disorder later in life

Substance use disorder Using more and more to get desired effect Continued use despite it causing issues with work/family Giving up activities/responsibilities due to substance use Inability to cut down/stop Dangerous use Cravings and urges to use Withdrawal symptoms (Mild, Moderate, Severe)

QUESTIONS?

Respiratory Depressants: What are opioids? Painkillers: Drugs that act on the nervous system to relieve pain. Attach/ activate opioid receptors in the brain, spinal cord, and digestive tract to block pain and boost pleasure Respiratory Depressants: Slow down the nervous system and make it difficult to breathe

Types of opioids - Morphine - Codeine - Methadone - Fentanyl NATURAL: derived from the opium poppy plant - Morphine - Codeine SEMI SYNTHETIC: created in labs from natural opiate - Heroin - Oxycodone - Hydrocodone SYNTHETIC: Completely man-made - Methadone - Fentanyl

Hydrocodone (Vicodin) Hydromorphone Methadone Morphine Commonly Used Opioids Codeine Fentanyl Heroin Hydrocodone (Vicodin) Hydromorphone Methadone Morphine Oxycodone (OxyContin) Percocet

opioid receptors opioid

CANNOT BE WOKEN / NO RESPONSE TO STIMULI LIMP OR HEAVY LIMBS SLOW OR ABSENT BREATHING CANNOT BE WOKEN / NO RESPONSE TO STIMULI LIMP OR HEAVY LIMBS COLD CLAMMY SKIN / BLUE LIPS OR FINGERNAILS LOUD GURGLING OR SNORING SOUNDS PINPOINT PUPILS Opioid overdoses is essentially a respiratory emergency , so the first sign that you’re going to observe is dangerously slow breathing, or someone who isn’t breathing at all Pinpoint pupils is unique to narcotic opioid use

Opioid Reversal – Naloxone (Narca

Opioid Reversal – Naloxone Medication that reverse the effects of an OPIOID overdose SAFE – no potential for abuse or overdose LEGAL to carry in Massachusetts Can work in 1-3 mins Lasts for 30-90 mins Naloxone

RESTORES BREATHING

QUESTIONS?

Stark Statistics From 2000 to 2016, fatal opioid overdoses in Massachusetts increased __% Economic costs associated with substance use have been estimated to be as high as $___ billion annually In 2012, doctors in the U.S. wrote ___ million prescriptions for opioid painkillers More than __million Americans currently meet the criteria for an opioid use disorder In Massachusetts Fentanyl was present in __% of deaths in 2017 __% of heroin users reported using prescription opioids prior to heroin  __% of MA residents know someone who is addicted to opioids 453 700 259 2 81 80 56

What Can I Do…?

What you can do AT HOME MANAGE MEDICATIONS PREVENTION Understand your risk by learning about any family history of SUD Ask prescribers about their policies regarding prescribing opioids and any non-opioid alternatives they recommend for effectively managing pain Ask PCP’s about whether they are trained to treat people with addiction Store medications in a spot where they cannot be accessed by children, teenagers, or family members with histories of SUD Dispose of opioids & other medications that you are not using (Framingham Police Department) Teach your children that they should only take medication that has been prescribed to them Monitor medications that your teen may be using to relieve headaches, pain or soreness from sports, or minor colds

What you can do IN YOUR COMMUNITY DONATE BECOME TRAINED TO USE NARCAN LEAD BY EXAMPLE Consider raising money or collecting gifts for local treatment organizations and sober homes. Reminding those who are struggling that there are folks who are rooting for them can send a powerful message to them that they are valued and give them the boost they need to continue working at their recovery Model non-stigmatizing language Intervene and help correct people when you hear or see insensitive language being used The Framingham Health Department offers free, anonymous training on how to recognize an opioid overdose and administer narcan

Language matters Person with a substance use disorder Person with an alcohol use disorder Person in recovery Negative / Positive Abstinent Substance use disorder Addict, Junkie, Druggie, Crackhead Alcoholic, Drunk Ex-addict Clean / Dirty (for drug test results) Clean (to describe a person) Drug habit

QUESTIONS?

want to learn more... Dreamland – Sam Quinones The Big Fix – Tracey Helton Mitchell Pain Killer – Barry Meier Dopesick – Beth Macy Drug Dealer, MD – Anna Lembke

References Massachusetts Department of Public Health CDC SAMHSA NIDA ASAM NIH JRI Rise The Harm Reduction Coalition Shatterproof National Vital Statistics

Thank you! Kelly Joseph, MS Program Coordinator City of Framingham w: 508.532.5470 kej@framinghamma.gov