1. Opioid Use Disorders: Recognition and Pharmacotherapy Review
Joji Suzuki, MD
Director, Division of Addiction Psychiatry
Department of Psychiatry,
Brigham and Women’s Hospital
Assistant Professor of Psychiatry,
Harvard Medical School

2. Epidemiology Update: How Did We Get Here?

3. Overview Overview of current state
Deaths caused by drug-related overdoses vs traffic accidents
How we got here: three key developments
Started in the early 90’s and have a direct impact in the present
Non-medical or recreational use
Most common opioid sources
What happens after recreational use begins?

4. Overview Overview of current state
Deaths caused by drug-related overdoses vs traffic accidents
How we got here: three key developments
Started in the early 90’s and have a direct impact in the present
Non-medical or recreational use
Most common opioid sources
What happens after recreational use begins?

5. Overview Overview of current state
Deaths caused by drug-related overdoses vs traffic accidents
How we got here: three key developments
Started in the early 90’s and have a direct impact in the present
Non-medical or recreational use
Most common opioid sources
What happens after recreational use begins?

6. Drug-related overdoses

7. Drug-related overdoses
2014: 28,000 deaths in the US
Drug-related overdoses

8. Drug-related overdoses
2014: 28,000 deaths in the US
70 deaths everyday
Drug-related overdoses

9. Drug-related overdoses
Traffic accidents
2014: 28,00 deaths in the US
70 deaths everyday
Drug-related overdoses

10. Drug overdoses: leading cause of accidental death
Motor vehicle accidents
Drug overdoses: leading cause of accidental death
Drug induced overdose

11. More deaths from prescription opioids than heroin

12. Overdose deaths/100,000
Opioid sales/10,000

13. How did we get here?

14. “Improve pain management”
Elderly, HIV patients, cancer
1980
1990
2000

15. 1990 “Improve pain management” Elderly, HIV patients, cancer
“Opioids? Be careful”
1980
1990
2000

16. 1990 “Improve pain management” Elderly, HIV patients, cancer
“Opioids? Be careful”
Changes
1980
1990
2000

17. Pain assessment
“Fifth vital sign”

18. Greater opioid utilization
Pain assessment
Greater opioid utilization
“Fifth vital sign”

19. Pain assessment “Fifth vital sign”
Greater opioid utilization
“Fifth vital sign”
Insufficient training in multimodal treatment

20. Unethical Marketing Unethical Marketing
“Non-addictive version of short-acting oxycodone”
Oxycontin (Oxycodone CR)
(1996)

21. Unethical Marketing Unethical Marketing No evidence to support claim
“Non-addictive version of short-acting oxycodone”
No evidence to support claim
Oxycontin (Oxycodone CR)
(1996)

22. Non-medical use
Unused opioids

23. Non-medical (recreational) use:
Opioids used for purposes other than they were prescribed
Self-medicate negative moods
Self-medicate insomnia
Enjoy euphoria
Diversion
Snorting

24. Non-medical (recreational) use:
Opioids used for purposes other than they were prescribed
Self-medicate negative moods
Self-medicate insomnia
Enjoy euphoria
Diversion
Snorting

25. Source of misused prescription opioids
SAMHSA, 2013

26. SAMHSA, 2013

27. Some will be able to stop
Escalation
Heroin is much cheaper
Physical withdrawal
Strong cravings
Financially challenging
Overdose risk increases dramatically
Snorting
Injecting

28. Some will be able to stop
Escalation
Heroin is much cheaper
Physical withdrawal
Strong cravings
Financially challenging
Overdose risk increases dramatically
Snorting
Injecting

29. Some will be able to stop
Escalation
Heroin is much cheaper
Physical withdrawal
Strong cravings
Financially challenging
Overdose risk increases dramatically
Snorting
Injecting

30. Some will be able to stop
Escalation
Heroin is much cheaper
Physical withdrawal
Strong cravings
Financially challenging
Overdose risk increases dramatically
Snorting
Injecting

31. Some will be able to stop
Escalation
Transition to heroin
Physical withdrawal
Strong cravings
Financially challenging
Overdose risk increases dramatically
Snorting
Injecting

32. Some will be able to stop
Escalation
Transition to heroin
Physical withdrawal
Strong cravings
Financially challenging
Overdose risk increases dramatically
Snorting
Injecting

33. Illicitly produced fentanyl
Cheap
Widely available
Incorporated into heroin
Counterfeit tablets
Many patients have no idea they are using it

34. Illicitly produced fentanyl
Cheap
Widely available
Incorporated into heroin
Counterfeit tablets
Many patients have no idea they are using it

35. Illicitly produced fentanyl
Cheap
Widely available
Incorporated into heroin
Counterfeit tablets
Many patients have no idea they are using it

36. Key Points Drug overdoses: now the leading cause of accidental death
Overdose deaths linked to increase in opioid prescriptions
Drug diversion
Most common source: family and friends
Most of these prescriptions come from a single doctor
Recreational use
Some individuals will escalate
Some of them even up to IV heroin

37. Key Points Drug overdoses: now the leading cause of accidental death
Overdose deaths linked to increase in opioid prescriptions
Drug diversion
Most common source: family and friends
Most of these prescriptions come from a single doctor
Recreational use
Some individuals will escalate
Some of them even up to IV heroin

38. Key Points Drug overdoses: now the leading cause of accidental death
Overdose deaths linked to increase in opioid prescriptions
Drug diversion
Most common source: family and friends
Most of these prescriptions come from a single doctor
Recreational use
Some individuals will escalate
Some of them even up to IV heroin

39. Key Points Drug overdoses: now the leading cause of accidental death
Overdose deaths linked to increase in opioid prescriptions
Drug diversion
Most common source: family and friends
Most of these prescriptions come from a single doctor
Recreational use
Some individuals will escalate
Some of them even up to IV heroin